PrimaryFoot CarePrimary

Foot Care

Common Nail ProblemsCommon Nail Problems

When toRefer?

When toRefer?

Fungal NailsFungal Nails

Fungal Nails - Treatment

• Routine Debridement

• Topical Agents

• Oral Agents

• Routine Debridement

• Topical Agents

• Oral Agents

Oral AgentsOral Agents• Fluconazole (Diflucan)

• Itraconazole (Sporanox)

• Ketoconazole (Nizoral)

• Griseofulvin (Gris-peg)

• Terbinafine (Lamisil)

• Fluconazole (Diflucan)

• Itraconazole (Sporanox)

• Ketoconazole (Nizoral)

• Griseofulvin (Gris-peg)

• Terbinafine (Lamisil)

Fungal Nails - TreatmentFungal Nails - Treatment

When toRefer?

When toRefer?

Pedal Skin ProblemsPedal Skin Problems

• Tinea Pedis

• Verrucae

• Corns & Callouses

• Tinea Pedis

• Verrucae

• Corns & Callouses

Tinea PedisTinea Pedis

Tinea Pedis - Etiology

• Dermatophytes– Trichophyton

– Epidermophyton

– Microsporum

• Saprophytes and Yeast

• Bacteria

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

When toRefer?

When toRefer?

VerrucaeVerrucae

When toRefer?

When toRefer?

Corns & CallousesCorns & Callouses

Corns - When to Refer?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

Morton’s Neuroma - EtiologyMorton’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

Interosseous TendonsInterosseous Tendons

IntermetatarsalSpace

IntermetatarsalSpace

Dorsal DigitalNerves

Dorsal DigitalNerves

Morton’sNeuromaMorton’sNeuroma Deep Transverse

IntermetatarsalLigament

Deep TransverseIntermetatarsalLigament

Plantar DigitalNervesPlantar DigitalNerves

Flexor DigitorumLongus TendonFlexor DigitorumLongus Tendon

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

When toRefer?

When toRefer?

Hammertoes -Conservative TreatmentHammertoes -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

Pre-OpPre-Op

Post-OpPost-Op

Pre-OpPre-Op

Post-OpPost-Op

Hammertoes - When to Refer?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

190

When toRefer?

When toRefer?

Heel PainHeel Pain

Heel Pain - EtiologyHeel 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

Heel Spur Syndrome/Plantar FasciitisHeel 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 TreatmentConservative Treatment

FlatfootFlatfoot

When toRefer?

When toRefer?

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:

When toRefer?

When toRefer?

ConclusionConclusion