6112019

114

Tintinallirsquos Emergency Medicine A Comprehensive Study Guide 8e

Chapter 285 So Tissue Problems of the Foot Mitchell C Sokolosky

INTRODUCTION

This chapter discusses the common foot disorders that are likely to present to the ED Patients with chronicor complicated foot problems generally should be referred to a dermatologist orthopedist general surgeonor podiatrist depending on the disease and local resources Tinea pedis foot ulcers and onychomycosis arediscussed in Section 20 Skin Disorders in chapter 253 Skin Disorders Extremities Puncture wounds ofthe foot are discussed in Section 6 Wound Management in chapter 46 Skin Disorders ExtremitiesPuncture Wounds and Bites Foot ulcers and osteomyelitis are discussed in Section 17 EndocrineDisorders in chapter 224 Type 2 Diabetes Mellitus

CORNS AND CALLUSES

Calluses are a thickening of the outermost layer of the skin and are a result of repeated pressure or irritationCorns (clavus) develop similarly but have a central hyperkeratotic core that is oen painful The causes canbe external (poorly fitted shoe) or internal (bunion)

Calluses are protective and should not be treated if they are not painful Calluses grow outward but may bepushed inward by continued pressure and become corns Corns also develop in areas of scarring andbetween toes Corns are classified as hard or so Hard corns are seen over bony protuberances where theskin is dry So corns are seen between toes where the skin is moist Corns may be painful or painless butpressure on the corn usually produces pain Diagnosis is based on clinical appearance Corns interrupt thenormal dermal lines and can thus be dierentiated from calluses which do not interrupt the normal dermallines Hard corns may resemble warts However when warts are pared warts contain black seeds which arethrombosed capillaries and may bleed while corns do not bleed So corns resemble tinea and identifying

tinea is important for proper treatment (see chapter 253)12

Keratotic lesions may indicate more severe underlying disease deformity local foot disorder or mechanicalproblem Dierential diagnosis of keratotic lesions includes syphilis psoriasis arsenic poisoning rosacea

lichen planus basal cell nevus syndrome and rarely malignancies2

TREATMENT OF CORNS

6112019

214

Treatment of symptomatic corns oen necessitates referral to a podiatrist because the treatment mayinvolve repeated paring use of keratolytic agents and possibly surgery to correct any underlying source of

pressure (bunion)1234 Salicylic acid treatments are more eective than paring with a scapel5 Recurrencecan be prevented by weekly gentle trimming with a pumice stone or emery board aer soaking in warmwater for 20 minutes Placing a pad on or around the lesion relieves pressure and avoiding constrictivefootwear also provides benefit

PLANTAR WARTS

Plantar warts are caused by the human papillomavirus Plantar warts are most common in children youngadults and butchers or fishmongers Infection occurs by skin-to-skin contact with maceration or sites oftrauma The incubation period is 2 to 6 months Spontaneous remission may occur in up to two thirds of

patients within 2 years6 Recurrence is common Single lesions are endophytic and hyperkeratotic A mother-daughter wart is similar to a single lesion except for a small vesicular satellite lesion Mosaic warts are oenpainless closely grouped and may coalesce Diagnosis is clinical The wart will obscure normal skinmarkings If in doubt use a 15 scalpel blade to pare down the lesion to expose thrombosed capillariescalled seeds The only two eective treatments for warts are salicylic acid and liquid nitrogen

(cryotherapy)78 Some salicylic acid preparations are available without a prescription Duct tape (silver or

clear) as an adjunct provides no benefit8 Adequate paring is required for larger lesions7 Plantar warts mayrequire prolonged treatment (several weeks or months) as well as cryotherapy so refer to a dermatologist or

podiatrist for follow-up8 Nonhealing lesions require referral to a specialist because they may represent

undiagnosed melanoma79 Instruct patients to avoid touching warts on themselves or others to wearslippers in public showers and to not use paring down tools (pumice stone file) on normal skin or nails

INGROWN TOENAIL

Normal nail function requires maintenance of a small space between the nail and the lateral nail foldsIngrown toenails occur when irritation of the tissue surrounding the nail causes overgrowth obliterating the

space101112 Causes include improper nail trimming using sharp tools to clean the nail gutters tight

footwear rotated digits and bony deformities1012 Curvature of the nail plate is another predisposing

factor12 Symptoms are characterized by inflammation swelling or infection of the medial or lateral aspectof the toenail The great toe is the most commonly aected In patients with underlying diabetes or arterialinsuiciency cellulitis ulceration and necrosis may lead to gangrene if treatment is delayed

TREATMENT OF INGROWN TOENAILS

If infection or significant granulation is absent at the time of presentation accepTable treatment is daily

elevation of the nail with placement of a wisp of cotton or dental floss between the nail plate and the skin13

6112019

314

Daily foot soaks and avoidance of pressure on the nail help13 Another option if no infection is present is to

remove a small spicule of the nail (Figure 285-1)12

FIGURE 285-1

Partial toenail removal This method is used for small nail fold swellings without infection Aer antisepticskin preparation and digital nerve block an oblique portion of the aected nail is trimmed about one to twothirds of the way back to the posterior nail fold Use scissors to cut the nail use forceps to grasp and removethe nail fragment

A digital nerve block is placed (see Section 5 Analgesia Anesthesia and Procedural Sedation and chapter36 Local and Regional Anesthesia) Cleanse the area and prepare the skin for an antiseptic procedure Triman oblique portion of the aected nail about one to two thirds of the way back to the posterior nail fold The

nail groove should then be debrided and a nonadherent dressing placed1011

If granulation or infection is present a larger partial removal of the nail plate is indicated (Figure 285-2)

Preprocedure antibiotics are not needed unless the patient is systemically ill14 First perform a digital nerveblock and prepare the area for antiseptic technique Longitudinally cut the entire aected area base-to-tipcutting about one fourth of the nail plate including the portion of the nail beneath the cuticle Cutting thenail is made easier by first sliding mosquito forceps or small scissors between the nail and nail bed on theaected side freeing the nail from the bed below Rotate the forceps turning up the portion of the nail onthe aected side A nail splitter is the optimal instrument for cutting the nail however sturdy scissors are areasonable alternative Then grasp the aected cut portion of the nail with a hemostat and using a rocking

motion remove it from the nail groove Then debride the nail groove10 Once the procedure is completedplace a nonadherent gauze or antibiotic ointment on the wound and a bulky dressing over that covering the

toe Check the toe in 24 to 48 hours1012 If phenol is used for chemical matricectomy massage the involvednail matrix vigorously with a cotton-tipped swab dipped in an aqueous solution of phenol 88 with arotation directed toward the lateral nail fold for 1 minute Irrigate the nail matrix using isopropyl alcohol to

neutralize completely the phenol solution1516 Do not expose normal skin or tissues to the phenol solution

Postprocedure antibiotics are not needed unless cellulitis is proximal to the toe11

FIGURE 285-2

6112019

414

Partial toenail removal (infection present) This method is used for onychocryptosis in the setting ofsignificant granulation tissue or infection See Treatment of Ingrown Toenails for a description of theprocedure

For recurrent ingrown toenails refer to a podiatrist for permanent nail ablation which may require a

combination of surgical excision plus chemical matricectomy (phenol ablation)1516

OTHER NAIL LESIONS

Other common toenail alictions include paronychia (see Section 23 Musculoskeletal Disorders chapter283 Nontraumatic Disorders of the Hand) and subungual hematoma (see Section 6 WoundManagement chapter 43 Arm and Hand Lacerations) which are treated similarly to when they occur inthe fingers Hyperkeratotic toenails can be a problem in the elderly These may become so severe as to aectgait and cause ulcerations and infections Refer such patients to podiatry for repeated trimming or nail plateremoval

BURSITIS INVOLVING FEET

Calcaneal bursitis causes posterior heel pain that is similar to Achilles tendinopathy1718 however the painand local tenderness are located at the posterior heel at the Achilles tendon insertion point In contrastAchilles tendinopathy causes symptoms 2 to 6 cm superior to the posterior calcaneus Pathologic bursae canbe divided into noninflammatory inflammatory suppurative and calcified Noninflammatory bursae areusually pressure induced and are found over bony prominences Inflammatory bursitis is commonly due togout or rheumatoid arthritis Suppurative bursitis is due to bacterial invasion of the bursae (primarilystaphylococcal species) usually from adjacent wounds Acute bursitis can lead to the formation of a

hygroma or calcified bursae Diagnosis can be aided by the use of US and MRI17 but is not indicated forevaluation in the ED Treatment of the bursitis depends on its cause For nonseptic bursitis symptoms

6112019

514

usually resolve with simple measures including heel lis comforTable footwear rest ice and nonsteroidal

anti-inflammatory drugs19 Management of septic bursitis is discussed in Section 23 MusculoskeletalDisorders in chapter 284 Joints and Bursae Diagnosis of these lesions is dependent on analysis of bursal

fluid which can be obtained by large-bore needle aspiration17

PLANTAR FASCIITIS

Plantar fasciitis inflammation of the plantar aponeurosis is the most common cause of heel pain202122

Peak age incidence is usually between 40 and 60 years old but it has a younger peak in runners2324 Plantarfasciitis is common among ballet dancers and those performing aerobics The plantar fascia anchors theplantar skin to the bone and provides support to the foot during gait The cause is usually overuse Othercauses of heel pain include abnormal joint mechanics tightness of the Achilles tendon shoes with poor

cushioning abnormal foot position and anatomy and obesity1720 In the younger patient autoimmune andrheumatic diseases can be considered

The symptom of plantar fasciitis is pain on the plantar surface of the foot that is worse when initiatingwalking Examination usually reveals a point of deep tenderness at the anterior medial aspect of thecalcaneus the point of attachment of the plantar fascia Pain and tenderness tend to be increased upondorsiflexion of the toes Diagnosis is clinical Radiographic studies are not indicated unless other causes arebeing considered The presence of heel spurs is of no diagnostic value because many patients withoutplantar fasciitis have this finding on imaging For resistant cases US and MRI may aid in diagnosis but are not

indicated for evaluation in the ED17

Plantar fasciitis is generally a self-limited disease Eighty percent of cases resolve spontaneously within 12months Initial treatment consists of rest ice nonsteroidal anti-inflammatory drugs heel and arch supportshoe inserts taping or strapping of the foot and dorsiflexion night splints (molded ankle-foot orthotics thatholds the plantar fascia and Achilles tendon stretched) Plantar-specific stretch exercises are the mostbeneficial treatment in the acute phase with the ankle dorsiflexed the patient uses one hand to dorsiflex the

toes and with the other hand palpates the plantar surface of the foot confirming tension25 Patients shouldbe taught Achilles tendon stretching exercises and be told to avoid the use of flat shoes and barefoot

walking17 In severe cases a short-leg walking boot may be useful to unload and rest the plantar fascia

Corticosteroid injections provide short-term benefit up to 1 month25 but are associated with plantar fascia

rupture17 and are best le to the orthopedist2021 Refer patients to a podiatrist orthopedist or primary care

physician for follow-up care2021

NERVE ENTRAPMENT SYNDROMES

TARSAL TUNNEL SYNDROME

6112019

614

Tarsal tunnel syndrome is an uncommon source of foot pain and numbness in runners due to compression of

the posterior tibial nerve as it courses behind the medial malleolus2627 The cause is usually from prior

injury (scar tissue bone or cartilage fragments or bony spurs) and overpronation during running2627

Overpronation (inward rotation) makes the nerve more vulnerable both to direct trauma from stretch and to

indirect trauma from inflammation of the surrounding structures resulting in compression2627 Othercauses include activities requiring restrictive footwear (ski boots skates) edema from pregnancy ganglion

cysts and tumors but frequently no inciting event is known28

Symptoms include numbness or burning pain of the sole and may be limited to the heel mimicking plantarfasciitis Distal calf pain may be due to retrograde radiation (Valleix phenomenon) Weakness is uncommonPain is oen worse with running at night and aer standing and oen leads to the desire to remove theshoes Tinel sign is positive with percussion inferior to the medial malleolus yielding pain radiating to themedial or lateral plantar surface of the foot Simultaneous dorsiflexion and eversion of the ankle exacerbates

symptoms Diagnosis is aided by nerve conduction studies or MRI2627 but these are not routinely orderedfrom the ED

The dierential diagnosis includes plantar fasciitis and if limited to the heel Achilles tendinitis Plantarfasciitis will cause point tenderness over the plantar heel and pain is worse upon morning standing Tarsaltunnel syndrome causes greater medial heel and arch pain due to involvement of the abductor hallucismuscle Tarsal tunnel pain worsens with ambulation throughout the day In addition tarsal tunnel syndromemay produce distal calf pain whereas plantar fasciitis does not

Initial treatment includes avoidance of the exacerbating activities nonsteroidal anti-inflammatory drugsshoe modification and occasionally orthotics If there is no improvement or symptoms recur aer a few

weeks then orthopedic evaluation is recommended2627

DEEP PERONEAL NERVE ENTRAPMENT

Deep peroneal nerve entrapment occurs most commonly at the location where the nerve courses under the

inferior extensor retinaculum29 (Figure 285-3) Recurrent ankle sprains so tissue masses trauma (both

acute and repetitive)30 chronic biomechanical misalignment edema and tight-fitting footwear (ski boots)are the most common causes Symptoms are dorsal and medial foot pain and sensory hypoesthesia at thefirst toe web space There may be loss of the ability to hyperextend the toes due to wasting of the extensorhallucis brevis and extensor digitorum brevis muscles Pain and tenderness can be elicited on palpation ofthe peroneal nerve at the site of entrapment and by plantar flexion with inversion of the foot Pain isexacerbated by activity and relieved by rest Nighttime pain is common Treatment is the same as for tarsaltunnel syndrome

FIGURE 285-3

Tendons of the foot anterior view including deep peroneal nerve

6112019

714

GANGLIONS OF THE FOOT

A ganglion is a common benign synovial cyst Ganglions are 15 to 25 cm in diameter and are oen attachedto a joint capsule or tendon sheath Although ganglions typically occur in the wrist or hand they may alsooccur in the foot Ganglions typically arise in the anterolateral aspect of the ankle but can occur in manyareas of the foot The cause is unknown Ganglions may appear suddenly or gradually may enlarge anddiminish in size and may be painful or asymptomatic On examination a ganglion is a firm cystic lesionDiagnosis is usually made clinically although US or MRI may exclude other causes when serious pathology issuspected Aspiration and instillation of glucocorticoids by an orthopedist lead to the complete resolution of

ganglions in some cases31 with surgical excision required for persistence3233

TENDON LESIONS OF THE FOOT

TENOSYNOVITIS AND TENDINITIS

Tenosynovitis and tendinitis may occur in the foot usually due to overuse Patients present with pain overthe involved tendon (Figure 285-3) The flexor hallucis longus posterior tibialis and Achilles tendon are most

commonly involved34 Treatment consists of rest ice and oral nonsteroidal anti-inflammatory drugs34

Flexor hallucis longus tenosynovitis classically aects ballet dancers but can also be seen in runners andnonathletes Presentation is similar to plantar fasciitis and tarsal tunnel syndrome Posteromedial anklepain medial arch pain and a positive Tinel sign (see earlier description in Tarsal Tunnel Syndrome) areseen Conservative management (rest mobilization orthotic shoe implant nonsteroidal anti-inflammatorydrugs) is usually successful Surgery is reserved for refractory cases

6112019

714

GANGLIONS OF THE FOOT

A ganglion is a common benign synovial cyst Ganglions are 15 to 25 cm in diameter and are oen attachedto a joint capsule or tendon sheath Although ganglions typically occur in the wrist or hand they may alsooccur in the foot Ganglions typically arise in the anterolateral aspect of the ankle but can occur in manyareas of the foot The cause is unknown Ganglions may appear suddenly or gradually may enlarge anddiminish in size and may be painful or asymptomatic On examination a ganglion is a firm cystic lesionDiagnosis is usually made clinically although US or MRI may exclude other causes when serious pathology issuspected Aspiration and instillation of glucocorticoids by an orthopedist lead to the complete resolution of

ganglions in some cases31 with surgical excision required for persistence3233

TENDON LESIONS OF THE FOOT

TENOSYNOVITIS AND TENDINITIS

Tenosynovitis and tendinitis may occur in the foot usually due to overuse Patients present with pain overthe involved tendon (Figure 285-3) The flexor hallucis longus posterior tibialis and Achilles tendon are most

commonly involved34 Treatment consists of rest ice and oral nonsteroidal anti-inflammatory drugs34

Flexor hallucis longus tenosynovitis classically aects ballet dancers but can also be seen in runners andnonathletes Presentation is similar to plantar fasciitis and tarsal tunnel syndrome Posteromedial anklepain medial arch pain and a positive Tinel sign (see earlier description in Tarsal Tunnel Syndrome) areseen Conservative management (rest mobilization orthotic shoe implant nonsteroidal anti-inflammatorydrugs) is usually successful Surgery is reserved for refractory cases

6112019

814

TENDON LACERATIONS

Tendon lacerations can result from penetrating injuries to the dorsal or plantar aspect of the foot Tendon

repairs in the foot are complex and orthopedic consultation is needed for repair34

The foot should be casted in dorsiflexion aer the repair of extensor tendons and in equinus aer repair offlexor tendons

TENDON RUPTURES

Spontaneous rupture of the Achilles tendon is common Rupture of the anterior tibialis and posterior tibialis

tendons may also occur34 Age and chronic corticosteroid and fluoroquinolone use are risk factors forspontaneous rupture Diagnosis is usually clinical but is aided by US or MRI studies in diicult cases

Achilles tendon rupture occurs when a sudden shear stress such as sudden pivoting on a foot or rapidacceleration is applied to an already weakened or degenerative tendon Many patients report immediatesharp pain and some hear an audible pop The peak age for rupture is 30 to 40 years and rupture is four to

five times more common in men than women35 Over 80 of ruptures occur during recreational sports(weekend warrior) Patients oen present with pain a palpable defect in the area of the tendon andinability to stand on tiptoes A minority of patients with complete tendon ruptures are able to ambulate andmay be misdiagnosed as having an ankle sprain Squeezing the calf of the prone patient whose knee is flexedat 90 degrees will normally cause the foot to plantar flex (calf squeeze or Thompson test The absence ofplantar flexion indicates a positive test indicative of rupture Initial ED treatment consists of ice analgesicsimmobilization of anklefoot in plantar flexion crutches and referral to an orthopedic surgeon Definitivetreatment is generally surgical in younger patients and conservative (casting in equinus or plantar flexion) in

older patients343637 For further discussion see chapter 44 Leg and Foot Lacerations and Figure 44-1(Thompson test) in that chapter in Section 6 Wound Management

Ruptures of the anterior tibialis tendon are rare Ruptures usually occur aer the fourth decade and are notexcessively painful Patients present with varying degrees of foot drop and a palpable defect distal to the

ankle joint in the area of the tendon In most cases disability is minimal and surgery is not necessary34

Spontaneous ruptures of the posterior tibialis tendon also occur aer the fourth decade Two thirds of thesecases occur in women The presentation is usually chronic and insidious Patients notice a gradual flatteningof their arch with modest discomfort and swelling over the medial ankle Examination reveals absence of thetendons normal prominence and weakness on inversion of the foot Patients find it impossible to stand ontiptoes Treatment may be conservative or surgical depending on the duration of the tear and activity of the

patient22

Flexor hallucis longus rupture presents as a loss of plantar flexion of the great toe The need for surgery will

depend on the patients occupation and lifestyle34

6112019

914

Disruption of the peroneal retinaculum can occur as a result of direct trauma during dorsiflexion of the footBesides pain localized to the peroneal tendon behind the lateral malleolus the patient complains of aclicking when walking as the tendon subluxes Peroneal tendon injuries may lead to lateral ankle instability

Treatment is generally surgical repair34

PLANTAR INTERDIGITAL NEUROMA (MORTONS NEUROMA)

Neuromas may form in a plantar digital nerve usually proximal to its bifurcation Neuromas may occur in anyof the digital nerves but are most common in the third interspace The cause is thought to be local irritationof the nerve due to entrapment usually from tight-fitting shoes Women between the ages of 25 and 50 yearsold are the most commonly aected group Patients present with pain located in the area of the metatarsalhead The pain is described as burning cramping or aching Pain is worsened by ambulation and resolved byrest and removal of shoes The pain may radiate to the aected toes and patients may note numbness in thetoes Pain is usually easily reproduced upon palpation of the area and at times a mass is felt Diagnosis isusually made clinically but nerve conduction studies electromyograms US and MRI may be helpful attimes Conservative treatment consists of wearing wide shoes with good metatarsal head supports and

metatarsal head o-loading inserts38 Local glucocorticoid injections can sometimes be curative Surgicalremoval may be necessary for refractory symptoms

COMPARTMENT SYNDROMES OF THE FOOT

The foot has up to nine compartments Compartment syndrome occurs when an elevation of tissue pressurewithin one of these nonyielding fascial compartments impedes vascular flow The cause of compartment

syndrome is a high-energy injury (crush injury)39 associated with multiple fractures Compartmentsyndromes have been reported in association with foot and ankle fractures (especially calcaneal andLisfrancs fracturedislocation) burns contusions bleeding disorders postischemic swelling aer arterialinjury or thrombosis venous obstruction snakebites exercise and prolonged pressure to the aected area

(eg cast immobilization prolonged abnormal positioning)40 Diagnosis begins with a high index of clinicalsuspicion based on the mechanism of injury Pain out of proportion to injury is one of the early findingsAdditional symptoms include pain that is worsened on active or passive movement paresthesias andneurovascular deficits An absent pulse and complete anesthesia are late findings and may be diicult toassess due to underlying swelling The only reliable objective method to diagnose compartment syndrome isby obtaining compartment pressures using an intracompartmental pressure monitoring system (Stryker STICDevice [Stryker Kalamazoo MI] or similar equipment) A dierence between diastolic blood pressure and

intracompartmental pressure of lt30 mm Hg is an indication for fasciotomy41 Once the diagnosis is madefasciotomy should be performed emergently In the ED elevate the extremity to the level of the heartpending fasciotomy The sequelae of compartment syndrome range from transient neurologic compromiseto complete myoneural necrosis fibrosis and ischemic contractures The prognosis of compartment

6112019

1014

1

2

3

4

syndrome is directly related to the time delay in diagnosis and treatment (see Section 22 Injuries to Bones

and Joints chapter 278 Compartment Syndrome)41

Chronic exertional compartment syndrome is due to overuse42 Symptoms occur with exertion and arerelieved by rest Patients should be instructed to avoid overexertion and be referred for further investigationand treatment

MALIGNANT MELANOMA

Malignant melanoma of the foot accounts for up to 15 of all cutaneous melanomas Melanomas canpresent as an atypical pigmented or nonhealing lesion of the foot including the nail These malignanciesoen imitate more common foot disorders such as fungal infections foot ulcers and plantar warts Becauseprognosis is directly related to early diagnosis maintain a high index of suspicion for the diagnosis Acrallentiginous melanoma is an aggressive malignant tumor that more commonly aects nonwhites This tumorhas a predilection for the plantar surface of the foot It may present with atypical features leading to a delayin diagnosis and poor outcome All skin lesions that are either atypical or not healing despite treatment

should be referred for biopsy43

PRACTICE GUIDELINES

For heel pain the Journal of Foot and Ankle Surgery published a guideline The Diagnosis and Treatment ofHeel Pain A Clinical Practice GuidelinendashRevision This can be found online athttpwwwacfasorgResearch-and-PublicationsClinical-Consensus-DocumentsClinical-Consensus-Documents

REFERENCES

Bedinghaus JM Niedfeldt MW Over-the-counter foot remedies Am Fam Physician 64 791 2001 [PubMed 11563570]

Freeman DB Corns and calluses resulting from mechanical hyperkeratosis Am Fam Physician 65 22772002

[PubMed 12074526]

Singh D Bentley G Trevino SG Callosities corns and calluses BMJ 312 1403 1996 [PubMed 8646101]

Tlougan BE Mancini Aj Mandell JA et al Skin conditions in figure skaters ice-hockey players and speedskaters Sports Med 41 709 2011

[PubMed 21846161]

6112019

1014

1

2

3

4

syndrome is directly related to the time delay in diagnosis and treatment (see Section 22 Injuries to Bones

and Joints chapter 278 Compartment Syndrome)41

Chronic exertional compartment syndrome is due to overuse42 Symptoms occur with exertion and arerelieved by rest Patients should be instructed to avoid overexertion and be referred for further investigationand treatment

MALIGNANT MELANOMA

Malignant melanoma of the foot accounts for up to 15 of all cutaneous melanomas Melanomas canpresent as an atypical pigmented or nonhealing lesion of the foot including the nail These malignanciesoen imitate more common foot disorders such as fungal infections foot ulcers and plantar warts Becauseprognosis is directly related to early diagnosis maintain a high index of suspicion for the diagnosis Acrallentiginous melanoma is an aggressive malignant tumor that more commonly aects nonwhites This tumorhas a predilection for the plantar surface of the foot It may present with atypical features leading to a delayin diagnosis and poor outcome All skin lesions that are either atypical or not healing despite treatment

should be referred for biopsy43

PRACTICE GUIDELINES

For heel pain the Journal of Foot and Ankle Surgery published a guideline The Diagnosis and Treatment ofHeel Pain A Clinical Practice GuidelinendashRevision This can be found online athttpwwwacfasorgResearch-and-PublicationsClinical-Consensus-DocumentsClinical-Consensus-Documents

REFERENCES

Bedinghaus JM Niedfeldt MW Over-the-counter foot remedies Am Fam Physician 64 791 2001 [PubMed 11563570]

Freeman DB Corns and calluses resulting from mechanical hyperkeratosis Am Fam Physician 65 22772002

[PubMed 12074526]

Singh D Bentley G Trevino SG Callosities corns and calluses BMJ 312 1403 1996 [PubMed 8646101]

Tlougan BE Mancini Aj Mandell JA et al Skin conditions in figure skaters ice-hockey players and speedskaters Sports Med 41 709 2011

[PubMed 21846161]

6112019

1114

5

6

7

8

9

10

11

12

13

14

15

16

Farndon LJ Venon W Walters SJ et al The eectiveness of salicylic acid plasters compared with theusual scalpel debridement of corns a randomized controlled trial J Foot Ankle Res 6 40 2013

[PubMed 24063387]

Pyrhonen S Johansson E Regression of warts An immunological study Lancet 1 592 1975 [PubMed 47944]

DallOglio F DAmico V Nasca MR Micali G Treatment of cutaneous warts an evidence-based review AmJ Clin Dermatol 13 73 2012

[PubMed 22292461]

Kwok CS Bennett C Holland R Abbott R Topical treatments or cutaneous warts (review) CochraneDatabase Syst Rev 9 CD001781 2012

[PubMed 22972052]

Lipke MM An armamentarium of wart treatments Clin Med Res 4 273 2006 [PubMed 17210977]

Richert B Surgical management of ingrown toenails an update overview Dermatol Ther 25 498 2012 [PubMed 23210749]

Eekhof JA Van Wijk B Knuistingh Neven A van der Wouden JC Interventions for ingrowing toenailsCochrane Database Syst Rev 4 CD001541 2012

[PubMed 22513901]

Daniel CR Iorizzo M Tosti A et al Ingrown toenails Cutis 78 407 2006 [PubMed 17243428]

Senapati A Conservative outpatient management of ingrowing toenails J R Soc Med 79 339 1986 [PubMed 3723536]

Coacuterdoba-Fernaacutendez A Ruiz-Garrido G Canca-Cabrera A Algorithm for the management of antibioticprophylaxis in onychocryptosis surgery Foot 20 140 2010

[PubMed 20961749]

Zaraa I Dorbani I Hawilo A et al Segmental phenolization for the treatment of ingrown toenailstechnique report follow up of 146 patients and review of the literature Dermatol Online J 19 18560 2013

[PubMed 24011310]

Vaccari S Dika E Balestri R et al Partial excision of the matrix and phenolic ablation of the treatment ofingrowing toenail a 36 month follow-up of 197 treated patients Dermatol Surg 36 1288 2010

[PubMed 20573175]

6112019

1214

17

18

19

20

21

22

23

24

25

26

27

28

Thomas JL Christensen JC Kravitz SR et al The diagnosis and treatment of heel pain a clinicalpractice guidelinendashrevision 2010 J Foot Ankle Surg 49 S1 2010

[PubMed 20439021]

Lohrer H Nauch T Retrocalcaneal bursitis but not Achilles tendinopathy is characterized by increasedpressure in the retrocalcaneal bursa Clin Biomech 29 283 2014

[PubMed 24370462]

Aaron DL Patel A Kayiaros S Calfee R Four common types of bursitis diagnosis and management JAm Acad Orthop Surg 19 359 2011

[PubMed 21628647]

Buchbinder R Plantar fasciitis N Engl J Med 350 2159 2004 [PubMed 15152061]

Neufeld SK Cerrato R Plantar fasciitis evaluation and treatment J Am Acad Orthop Surg 16 338 2008 [PubMed 18524985]

Riddle DL Schappert SM Volume of ambulatory care visits and patterns of care for patients diagnosedwith plantar fasciitis a national study of medical doctors Foot Ankle Int 25 303 2004

[PubMed 15134610]

Furey JG Plantar fasciitis The painful heel syndrome J Bone Joint Surg Am 57 672 1975 [PubMed 1150711]

Taunton JE Ryan MB Clement DB et al A retrospective case-control analysis of 2002 running injuriesBr J Sports Med 36 95 2002

[PubMed 11916889]

Berbrayer D Fredericson M Update on evidenced-based treatments for plantar fasciopathy PMR 6 1592014

[PubMed 24365781]

Reade BM Longo DC Keller MC Tarsal tunnel syndrome Clin Podiatr Med Surg 18 395 2001 [PubMed 11499170]

DiDomenico LA Masternick EB Anterior tarsal tunnel syndrome Clin Podiatr Med Surg 23 611 2006 [PubMed 16958392]

Logullo F Ganino C Lupidi F et al Anterior tarsal tunnel syndrome a misunderstood and misleadingentrapment neuropathy Neurol Sci 35 773 2014

6112019

1314

29

30

31

32

33

34

35

36

37

38

39

[PubMed 24337947]

Parker RG Dorsal foot pain due to compression of the deep peroneal nerve by exostosis of themetatarsocuneiform joint J Am Podiatr Med Assoc 95 455 2005

[PubMed 16166463]

Hey HW Tan TC Lahiri A et al Deep peroneal nerve entrapment by a spiral fibular fracture J BoneJoint Surg Am 93 e113 2011

[PubMed 22005874]

Wu KK Ganglions of the foot J Foot Ankle Surg 32 343 1993 [PubMed 8339089]

Pontious J Good J Maxian SH Ganglions of the foot and ankle A retrospective analysis of 63procedures J Am Podiatr Med Assoc 89 163 1999

[PubMed 10220985]

Ahn JH Choy WS Kim HY Operative treatment for ganglion cysts of the foot and ankle J Foot AnkleSurg 49 442 2010

[PubMed 20650661]

Simpson MR Howard TM Tendinopathies of the foot and ankle Am Fam Physician 80 1107 2009 [PubMed 19904895]

Leppilahti J Puranen J Orava S Incidence of Achilles tendon rupture Acta Orthop Scand 67 277 1996 [PubMed 8686468]

Kader D Saxena A Movin T Maulli N Achilles tendinopathy some aspects of basic science and clinicalmanagement Br J Sports Med 36 239 2002

[PubMed 12145112]

Holm C Kjaer M Eliasson P Achilles tendon rupture treatment and complications a systematic reviewScand J Med Sci Sports March 20 2014

[PubMed [Epub ahead of print]

Thomson CE Gibson JN Martin D Interventions for the treatment of Mortons neuroma CochraneDatabase Syst Rev 3 CD003118 2004

[PubMed 15266472]

Thakur NA1 McDonnell M Got CJ et al Injury patterns causing isolated foot compartment syndrome JBone Joint Surg Am 94 1030 2012

[PubMed 22637209]

6112019

1414

40

41

42

43

Towater LJ Heron S Foot compartment syndrome a rare presentation to the emergency department JEmerg Med 44 e235 2013

[PubMed 22981663]

Frink M Hildebrand F Krettek C et al Compartment syndrome of the lower leg and foot Clin OrthopRelat Res 468 940 2010

[PubMed 19472025]

Bong MR Polatsch DB Jazrawi LM et al Chronic exertional compartment syndrome diagnosis andmanagement Bull Hosp Jt Dis 62 77 2005

[PubMed 16022217]

Franke W Neumann NJ Ruzicka T et al Plantar malignant melanomamdasha challenge for earlyrecognition Melanoma Res 10 571 2000

[PubMed 11198479]

USEFUL WEB RESOURCES

American Academy of Orthopedic Surgeons Web site for information concerning ankle and foot disordersmdashhttporthoinfoaaosorgmenusfootcfm

American Academy of Orthopedic Surgeons Web site for information about clinical practice guidelinesmdashhttpwwwaaosorgResearchguidelinesguideasp

Podiatry Network Web site concerning common foot disordersmdashhttppodiatrynetworkcomcommon_disorderscfm

McGraw HillCopyright copy McGraw-Hill Education

All rights reserved Your IP address is 7514824133

Terms of Use bull Privacy Policy bull Notice bull Accessibility

Access Provided by Brookdale University Medical CenterSilverchair