primary foot care primary foot care. common nail problems

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Primary Foot Care Primary Foot Care Slide 2 Slide 3 Common Nail Problems Slide 4 Slide 5 Slide 6 Slide 7 Slide 8 When to Refer? When to Refer? Slide 9 Fungal Nails Slide 10 Slide 11 Fungal Nails - Treatment Routine Debridement Topical Agents Oral Agents Routine Debridement Topical Agents Oral Agents Slide 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 Slide 13 Slide 14 Slide 15 When to Refer? When to Refer? Slide 16 Pedal Skin Problems Tinea Pedis Verrucae Corns & Callouses Tinea Pedis Verrucae Corns & Callouses Slide 17 Tinea Pedis Slide 18 Tinea Pedis - Etiology Dermatophytes Trichophyton Epidermophyton Microsporum Saprophytes and Yeast Bacteria Slide 19 Slide 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 Slide 21 When to Refer? When to Refer? Slide 22 Verrucae Slide 23 Slide 24 Slide 25 When to Refer? When to Refer? Slide 26 Corns & Callouses Slide 27 Slide 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 Slide 29 Slide 30 Mortons 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 Slide 31 Interosseous Tendons Interosseous Tendons Intermetatarsal Space Intermetatarsal Space Dorsal Digital Nerves Dorsal Digital Nerves Mortons Neuroma Mortons Neuroma Deep Transverse Intermetatarsal Ligament Deep Transverse Intermetatarsal Ligament Plantar Digital Nerves Plantar Digital Nerves Flexor Digitorum Longus Tendon Flexor Digitorum Longus Tendon Slide 32 Mortons 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 Slide 33 Slide 34 Slide 35 Slide 36 Slide 37 Slide 38 When to Refer? When to Refer? Slide 39 Slide 40 Slide 41 Slide 42 Slide 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 Slide 44 Slide 45 Slide 46 Slide 47 Pre-Op Post-Op Slide 48 Pre-Op Post-Op Slide 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 Slide 50 Slide 51 19 0 Slide 52 Slide 53 Slide 54 Slide 55 Slide 56 Slide 57 When to Refer? When to Refer? Slide 58 Heel Pain Slide 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 Slide 60 Slide 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 Slide 62 Slide 63 Slide 64 Slide 65 Slide 66 Slide 67 Slide 68 Slide 69 Slide 70 Flatfoot Slide 71 When to Refer? When to Refer? Slide 72 Slide 73 Slide 74 Slide 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: Slide 76 Slide 77 Slide 78 Slide 79 When to Refer? When to Refer? Slide 80 Conclusion