1. Primary Foot Care Primary Foot Care

3. Common Nail Problems

8. When to Refer? When to Refer?

9. Fungal Nails

11. Fungal Nails - Treatment Routine Debridement Topical Agents Oral Agents Routine Debridement Topical Agents Oral Agents

12. Fluconazole (Diflucan) Itraconazole (Sporanox) Ketoconazole (Nizoral) Griseofulvin (Gris-peg) Terbinafine (Lamisil) Fluconazole (Diflucan) Itraconazole (Sporanox) Ketoconazole (Nizoral) Griseofulvin (Gris-peg) Terbinafine (Lamisil) Fungal Nails - Treatment

15. When to Refer? When to Refer?

16. Pedal Skin Problems Tinea Pedis Verrucae Corns & Callouses Tinea Pedis Verrucae Corns & Callouses

17. Tinea Pedis

18. Tinea Pedis - Etiology Dermatophytes –Trichophyton –Epidermophyton –Microsporum Saprophytes and Yeast Bacteria

20. Tinea Pedis - Treatment Topical Agents –Imidazoles: miconazole, clotrimazole, sulconazole, etc. –Others: undecylenic acid, tolnaftate Oral Agents –Used in severe/resistant cases –Griseofulvin, ketoconazole –Fluconazole, itraconazole, terbinafine Local Care

21. When to Refer? When to Refer?

22. Verrucae

25. When to Refer? When to Refer?

26. Corns & Callouses

28. Corns - When to Refer? Multiple Lesions Multiple Digital Deformities as Cause Rigid Digital Contractures Ulcerative Lesion –Immediate –Definitive Diabetics, PVD, Neuropathic Multiple Lesions Multiple Digital Deformities as Cause Rigid Digital Contractures Ulcerative Lesion –Immediate –Definitive Diabetics, PVD, Neuropathic

30. Morton’s Neuroma - Etiology Narrow Shoes (Primary Cause) High Heels Biomechanical (Functional) Abnormalities –Excessive pronation –Flatfoot –Hammertoes Traumatic Anatomic Narrow Shoes (Primary Cause) High Heels Biomechanical (Functional) Abnormalities –Excessive pronation –Flatfoot –Hammertoes Traumatic Anatomic

31. Interosseous Tendons Interosseous Tendons Intermetatarsal Space Intermetatarsal Space Dorsal Digital Nerves Dorsal Digital Nerves Morton’s Neuroma Morton’s Neuroma Deep Transverse Intermetatarsal Ligament Deep Transverse Intermetatarsal Ligament Plantar Digital Nerves Plantar Digital Nerves Flexor Digitorum Longus Tendon Flexor Digitorum Longus Tendon

32. Morton’s Neuroma - Symptoms Burning Tingling Numbness (Usually only Subjective) Radiating Pain into the Involved Toes Feeling as Though “Walking on a Pea” or “Sock is Bunched Up” Strong Desire to Stop, Remove Shoe, and Massage Forefoot Burning Tingling Numbness (Usually only Subjective) Radiating Pain into the Involved Toes Feeling as Though “Walking on a Pea” or “Sock is Bunched Up” Strong Desire to Stop, Remove Shoe, and Massage Forefoot

38. When to Refer? When to Refer?

43. Hammertoes - Conservative Treatment Treat Only the Symptoms Aperature Pads Splints Extra-depth Shoes Caution When Using Acid Plasters In: –Diabetics –PVD –Neuropathic Treat Only the Symptoms Aperature Pads Splints Extra-depth Shoes Caution When Using Acid Plasters In: –Diabetics –PVD –Neuropathic

47. Pre-Op Post-Op

48. Pre-Op Post-Op

49. Hammertoes - When to Refer? Rigid Deformities Recurrent Ulceration Chronic Pain in All Types of Shoes Other Associated/Contributing Deformities Patient No Longer Satisfied with Conservative Therapy Rigid Deformities Recurrent Ulceration Chronic Pain in All Types of Shoes Other Associated/Contributing Deformities Patient No Longer Satisfied with Conservative Therapy

51. 19 0

57. When to Refer? When to Refer?

58. Heel Pain

59. Heel Pain - Etiology Plantar Fasciitis/Heel Spur Syndrome Heel Bursitis Nerve Entrapment Stress Fracture Systemic Arthritides Biomechanical Obesity Plantar Fasciitis/Heel Spur Syndrome Heel Bursitis Nerve Entrapment Stress Fracture Systemic Arthritides Biomechanical Obesity

61. Heel Spur Syndrome/ Plantar Fasciitis Rest Strap OTC Arch Support Custom Orthotic NSAIDs Injections - Cortisone Stretching Exercises Physical Therapy Rest Strap OTC Arch Support Custom Orthotic NSAIDs Injections - Cortisone Stretching Exercises Physical Therapy Conservative Treatment

70. Flatfoot

71. When to Refer? When to Refer?

75. Flatfoot - Why Treat? Bunion Deformity Hammer Digit Syndrome Metatarsalgia Chronic Plantar Fasciitis/HSS Postural Pains in Legs, Knees, Back Arthritis of Involved Joints (AJ,STJ,MTJ) Bunion Deformity Hammer Digit Syndrome Metatarsalgia Chronic Plantar Fasciitis/HSS Postural Pains in Legs, Knees, Back Arthritis of Involved Joints (AJ,STJ,MTJ) Conditions Associated with Untreated Flatfoot:

79. When to Refer? When to Refer?

80. Conclusion