Doctor Thierry HO-PUN-CHEUNG

Blisters, feet's bad smell, ingrown nail, tendinopathy…

FOOT's DISEASES

Tips for isolated doctor

Colloque médecine des missions extérieures 2008

- scorch / bullae (blisters)

- microtraumatic foot lesions

favored by:

- the constant wearing of shoes (RANGERS)

- intense physical effort , not progressive

- poor hygienehowever, the foot

= KEY SENSOR of the POSTURAL SYSTEM

ANY DISTURBANCE of ground SUPPORT

DISTURBANCE of POSTURE

and FOOT roll at STEP

CONSTRAINTS PATHOLOGIES

on LOWER LIMB, SPINE and PELVIS

3

1. PLANTAR HYPERHIDROSIS20% = WET SOCKS (even in winter)

Aftermath :

→ maceration + soft and fragile skin

- scorch, blisters

- Mycosis

- Bromhidrose (horrible smell)

If FOOT ORTHOTICS = airing every day

ANTIPERSPIRANT POWDER= Obstructs the pores by keratinization

HYDROCORTISON CREAMEVERY NIGHT

then 2 times per week

For maintenance

Irritating early !

TREATMENT of plantar HYPERHIDROSIS

if failure → IONOPHORESIS(Dermatologist otherwise cheap store)

4 sessions 30 min / week

then 1 / week, then 1 / month

KERATOLYSIS PUNCTUATED+++ Bad smell (Corynebacterium)

- povidone iodine = to lather

- antibiotic gel: 2 times per day for 15 days

- imidazole cream

classique = défaut de coupe2. NAIL EMBODIED = bad cutStade 1: wearing shoes PAIN

→ DENTAL WIRE / SUTURE WIRE

STRAPPING

Stage 2: painful inflammatory bead

→ Resection of the nail spur

+ Baths antiseptic toe

+ Povidone iodine gel bandage

Stade 3: PERMANENT PAIN = INFECTION

→ BUDDINGPYOGENIC GRANULOMA : EMLA®

→ CURETTAGE / dermocorticoid Lysis

If FAIL / RECIDIVISM:

→ Partial EXTRACTION OF the NAIL LAME

then matrix phenolization

3. FROSTBITE OF TOES

warm bath = 38°C + ANTISEPTIC

Aspirin 250 mg

BENIGN but PAINFUL

→ CHANGE SUPPORT

-TENDINOPATHIES

-IMBALANCE WALKS

Causes: plantar hyper support

or excessive skin on

per shoe / sock's foldSCORCH

= diffuse painful irritation of the skin (burning 1)

BLISTER

= localized scorch and serous detachment of the

dermis (superficial burns 2)

4. SCORCH and BLISTERS of FEET

= that of a 1st degree burn

disinfection

moisturizer

SCORCH Treatment

BLISTERS TreatmentA. FOR FINISH THE HIKE / WALK:

AVOID INFECTION = never put a wire in the blister !!!

DISINFECTION

VACUUM with STERILE NEEDLE AND SYRINGE

DRILL 3 HOLES

Dry

dressing protector Hydrocolloid

B. AT THE END OF WALK:DISINFECTION

if blister ceiling is torn : Cut it in a sterile way

let it outdoors, otherwise DRESSING PROTECTOR

Until the skin tans:

DRESSING PROTECTOR HYDROCOLLOID

SOCKS = SEAMLESS

if aggressive fold foothills of rangers

→ HOOF OIL BEEF

PLANTAR ORTHOSES if static disorder

→ reduces hyper support

Treat plantar hyperhidrosis and dry feet

BLISTERS - SCORCH PREVENTIONNB: Personal double-bind Study > 600 military : the anti-scorch creams and

cushioned midsoles were ineffective !!!

3 days before the march:

> 7 days before a long walk

→ LEMON JUICE

(citric acid)

Calcaneal tendon surrounded by sliding bursa

5. CALCANEAL BURSITIS

5.1. RETRO CALCANEAL BURSITIS

= RUBBING OF THE RETROCALCANEAL FAT BURSA

(Bovis bursa : located between the Achilles tendon and skin)

PAINFUL SWELLING BEHIND THE CALCANEAL TENDON

5.2. PRE CALCANEAL BURSITIS

= support of the rangers' foothills

crushes this bursa between

the calcaneal tendon

and the posterior superior face of the calcaneus.

failure → lateral radiograph

? hypertrophy posterior superior part of the

calcaneus tuberosity

= Haglund Disease+ - Surgical

exempted of shoes buttress

Dynamic Manual Adhesiolysis®

Icings

Bilateral heel damping = 1 cm high

CALCANEAL BURSITIS TREATMENT

SOFTEN THE FOOTHILLS OF THE RANGERS

= HOOF OIL BEEF

FLEXIBLE RANGERS

If failure → MESOTHERAPY

Dynamic Manual Adhesiolysis® +++: Calcaneal Tendon,

Soleus/Gastrocnemius,

Plantar Flexors…

Stretching

Strengthening

5.3. CALCANEAL TENDINOPATHIES (1/3 = BURSITIS)

strapping :

If compulsory Walk

painful foot edema + impotence

= Thinking

6. STRESS FRACTURES

Tuning Fork Test (128Hz)+++→ EXQUISITE PAIN

attenuation of sound propagation

STRESS

FRACTURE

+ Auscultation (Barford Test):

STRESS FRACTURE Treatment

Treating a vitamin D (Hormone D) deficiency

= Dynamic Manual Adhesiolysis®

SOFTEN Plantar fasciae:

- Shiatsu Massage Cushion +++

7.1. CORPOREAL PLANTAR FASCIITIS

7. PLANTAR FASCIITIS

Plantar pain + common in military > 40 years

7.2. PROXIMAL PLANTAR FASCIITIS

Dynamic Manual Adhesiolysis®

If failure: corticosteroid infiltration to the

insertion of FLEXOR PLANTARIS

heavy backpack (up to 30 kg)

favored by FLAT VALGUS FEET of the older walkers

+ - PLANTAR ORTHOSES

Analgesic TAPING

8. POSTERIOR TIBIALIS TENDINOPATHY

Tibial postérieur

TREATMENT

Dynamic Manual Adhesiolysis®

+ Strengthening FOOT ARCH

↘ ACID Food proportion (uric acid and oxalic acid)

which promote the precipitation of oxalate and sodium urate

crystals in the fasciae-tendon-muscle tissues → ADHESIONS

limiting excess:

MEAT, MEAT, DAIRY, peanut

TEA black, COFFEE / WHITE FLOUR, SUGAR

FACTORIES

↗ALKALINE Food:

FRUIT, VEGETABLE FEES

Natural FOOD FORM Omega-3, vitamin D

DIETARY common sense RULES

Avoid CHRONIC DEHYDRATION

which often precedes tendinopathy

9. Some GENERAL actions of PREVENTION

REPAY absolutely

the "SLEEP DEBT"

"This is the night

that the body regenerates"

Before a night march:

"preventive“ nap