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Palliative Care
1
Why Do We Reduce Toenails? Reduce pain
Prevent potential injury Subungual
ulceration Subungual
hematoma
Cosmesis
Not everyone is a candidate for definitive treatment
Reducing a toenail: Step 1—assess the patient
PVD?
Neuropathy?
Other immunocompromise?
Reducing a toenail: Step 2—collect needed materials
Gloves
Eye Protection
Gauze
Nail nippers
Bandaids
Reducing a toenail: Step 3—stabilize the toe
Reducing a toenail: Step 4—Reduce the toenail
Reducing a toenail: Watch for flying toenail
Don’t try this technique with thick toenails
Reducing a toenail: How far back do you cut?
Depends on the condition of the toenail
Reducing a toenail: Step 5—Smooth the nail surface
Reducing a toenail: Podospray
Why reduce corns and calluses?
Pain
Potential ulceration
Difficult definitive treatment
Not all patients are good candidates for surgical treatment
Corn Synonyms
Heloma durum (HD)
Excrescence
Hyperkeratosis
Hyperkeratotic papule
Callus Synonyms
Tyloma
Intractable Plantar Keratosis
Hyperkeratotic papule
Debriding a callus: Step 1—assess the patient
PVD?
Neuropathy?
Other immunocompromise?
Debriding a callus: Step 2—Gather appropriate materials Gauze
Blade handle
Blade
Kelly Forceps
Gloves
Debriding a callus: Step 3—Load the blade
Debriding a callus: Step 4—Hold the Blade
Debriding a callus: Step 4—Hold the Blade
Debriding a callus: Step 4—Hold the Blade
Debriding a callus: Step 5—Don’t forget negative pressure
Debriding a callus: Step 6—When do you stop?
Blood
Color
Texture
Skin Lines
Palliative Foot Care: What if you see blood?
Don’t say “oops” Inform the patient Hemostasis Clean with alcohol Dress with antibiotic Cover with a
bandaid Patient instructions Follow up
Hemostatic solutions
Palliative Foot Care: Billing Issues
C&C is not covered by Medicare, unless…
Normal toenails are not covered by Medi-Cal
Most private insurance co’s do not cover C&C