Diagnosis and Treatment of Diagnosis and Treatment of Common Foot ConditionsCommon Foot Conditions
Your Name and address hereYour Name and address here
What is a Podiatrist?What is a Podiatrist?
Specializes in diagnosis and treatment of Specializes in diagnosis and treatment of conditions effecting the foot, ankle and conditions effecting the foot, ankle and lower leg in all age groupslower leg in all age groups
Attends one of seven Colleges of Podiatric Attends one of seven Colleges of Podiatric Medicine for four yearsMedicine for four years
Completes a post-graduate residency Completes a post-graduate residency between one and four yearsbetween one and four years
Conditions We TreatConditions We Treat
DermatologicDermatologic OrthopedicOrthopedic NeurologicNeurologic Diabetes-related foot and ankle Diabetes-related foot and ankle
ailmentsailments
Dermatologic ConditionsDermatologic Conditions
OnychomycosisOnychomycosis ParonychiaParonychia VeruccaVerucca Tinea PedisTinea Pedis
Orthopaedic ConditionsOrthopaedic Conditions
Plantar FasciitisPlantar Fasciitis HammertoeHammertoe Bunion and Bunion and
bunionettebunionette Osteoarthritis and Osteoarthritis and
Bone spursBone spurs Sports medicine Sports medicine
related injuriesrelated injuries
Neurologic ConditionsNeurologic Conditions
NeuromaNeuroma Cutaneous Nerve Cutaneous Nerve
EntrapmentEntrapment NeuropathyNeuropathy Tarsal Tunnel Tarsal Tunnel
SyndromeSyndrome
Diabetes Related Foot and Ankle Diabetes Related Foot and Ankle ConditionsConditions
Neurotrophic UlcersNeurotrophic Ulcers NeuropathyNeuropathy Charcot FootCharcot Foot
OnychomycosisOnychomycosis
DermatophyteDermatophyte Often seen with skin Often seen with skin
manifestationsmanifestations Usually acquired but Usually acquired but
may be inheritedmay be inherited More treatable than in More treatable than in
the pastthe past Differentiate from Differentiate from
MelanomaMelanoma
Onychomycosis TreatmentOnychomycosis Treatment
DebridementDebridement TopicalTopical OralOral MatrixectomyMatrixectomy Nail Biopsy for Nail Biopsy for
dermatopathologydermatopathology
ParonychiaParonychia
Erythema and edema Erythema and edema of the ungual labiaof the ungual labia
Wide or incurvated Wide or incurvated nail platenail plate
May drain serous to May drain serous to purulent exudatepurulent exudate
Hallux most effectedHallux most effected
Paronychia TreatmentParonychia Treatment
Incision and DrainageIncision and Drainage Oral antibiotics usually Oral antibiotics usually
not necessarynot necessary Longstanding infection Longstanding infection
may require X-raymay require X-ray Chemical Chemical
matrixectomy, partial matrixectomy, partial or totalor total
Verruca? Verruca?
Verruca!Verruca!
Human Papilloma Human Papilloma Virus (HPV)Virus (HPV)
ContagiousContagious Usually plantar on Usually plantar on
footfoot
Verruca TreatmentVerruca Treatment
Debridement is diagnostic and Debridement is diagnostic and therapeutictherapeutic
ChemocauteryChemocautery Various topical treatments availableVarious topical treatments available Oral Cimetidine for pediatric usage Oral Cimetidine for pediatric usage
(30-40Mg/Kg in 3 divided doses)(30-40Mg/Kg in 3 divided doses) CurretageCurretage
Plantar FasciitisPlantar Fasciitis Inflammation and pain Inflammation and pain
of the plantar fascia, of the plantar fascia, usually at its insertion usually at its insertion at the plantar medial at the plantar medial tubercle of the tubercle of the calcaneouscalcaneous
Becomes chronic in 5-Becomes chronic in 5-10% of all patients10% of all patients
Is not necessarily Is not necessarily associated with a heel associated with a heel spurspur
Over 90% resolve with Over 90% resolve with conservative conservative treatmenttreatment
Plantar Fasciitis SymptomsPlantar Fasciitis Symptoms
Weight-bearing pain on Weight-bearing pain on arisingarising
Pain subsides, returns Pain subsides, returns with activitywith activity
Footwear related to pain?Footwear related to pain?
Plantar Fasciitis Risk FactorsPlantar Fasciitis Risk Factors
Weight gainWeight gain Equinus deformityEquinus deformity Poor shoegearPoor shoegear Biomechanical Biomechanical
abnormalitiesabnormalities Work SurfaceWork Surface
Plantar Fasciitis DiagnosisPlantar Fasciitis Diagnosis
Pain on palpation Pain on palpation Antalgic gaitAntalgic gait Pes planusPes planus X-rayX-ray UltrasoundUltrasound
Plantar Fasciitis TreatmentPlantar Fasciitis Treatment
StretchingStretching RICERICE Change shoesChange shoes OTC insertsOTC inserts
Plantar Fasciitis TreatmentPlantar Fasciitis Treatment
Nocturnal Anti-Nocturnal Anti-contracture contracture DevicesDevices
OrthoticsOrthotics NSAIDSNSAIDS Cortisone shot(s)Cortisone shot(s) Rarely surgeryRarely surgery
ESWTESWT
Heel LithotripsyHeel Lithotripsy Surgical alternativeSurgical alternative 72% effective72% effective 3 months until 3 months until
significant relief in significant relief in most patientsmost patients
Few complicationsFew complications
HammertoeHammertoe
Digital ContractureDigital Contracture Usually PIPJUsually PIPJ May have MPJ May have MPJ
dorsiflexiondorsiflexion May have clavusMay have clavus Pre-ulcerative in Pre-ulcerative in
patients with patients with diabetesdiabetes
Hammertoe TreatmentHammertoe Treatment
DebridementDebridement PaddingPadding Shoe gear changeShoe gear change Surgery as a last Surgery as a last
optionoption
Hallux Valgus Hallux Valgus
Painful bump Painful bump secondary to increase secondary to increase IM angleIM angle
Poor biomechanicsPoor biomechanics Hurts in shoesHurts in shoes Usually bump pain vs Usually bump pain vs
joint painjoint pain Wider shoes helpWider shoes help Orthotics slow or stop Orthotics slow or stop
progression and painprogression and pain
OsteoarthritisOsteoarthritis
Usually at first MPJUsually at first MPJ Hallux Hallux
limitus/rigiduslimitus/rigidus Poor biomechanicsPoor biomechanics Painful to walkPainful to walk
Osteoarthritis TreatmentOsteoarthritis Treatment
Cortisone injectionCortisone injection Physical therapyPhysical therapy NSAIDSNSAIDS OrthoticsOrthotics SurgerySurgery
Ankle - Foot OrthosisAnkle - Foot Orthosis
Articulated hinge Articulated hinge devicedevice
Used when Used when functional orthotic functional orthotic fails or will failfails or will fail
For active patient For active patient that can tolerate that can tolerate motionmotion
Excellent for sportsExcellent for sports
Ankle – Foot OrthosisAnkle – Foot Orthosis
Gauntlet style for Gauntlet style for total control total control
For patients that For patients that cannot tolerate cannot tolerate motionmotion
Good for severe Good for severe DJD and Charcot DJD and Charcot footfoot
Ankle SprainsAnkle Sprains Tear or stretching of the
ligaments of the ankle. Usually the ligaments on the outside of the ankle are involved.
Caused by and twisting injury of the foot / ankle .
Instability of the ankle can develop due to the ligament injury.
Most often treated conservatively. Surgical repair can be performed to treat chronic ankle sprains.
Ankle SprainsAnkle SprainsTreatmentTreatment
Immobilize early Immobilize early Consider Non-Consider Non-
Weight bearingWeight bearing RICERICE NSAIDSNSAIDS
Ankle SprainsAnkle SprainsRehabilitationRehabilitation
CAM walker to CAM walker to StirrupStirrup
Stirrup to gauntletStirrup to gauntlet Physical therapyPhysical therapy
Morton’s NeuromaMorton’s Neuroma
Painful swelling of the Painful swelling of the interdigital nerveinterdigital nerve
Most commonly seen Most commonly seen in third web spacein third web space
Patients can feel Patients can feel numbness of adjacent numbness of adjacent digits and plantar paindigits and plantar pain
Etiology is abnormal Etiology is abnormal stretching of the nervestretching of the nerve
Morton’s Neuroma Differential Morton’s Neuroma Differential DiagnosisDiagnosis
Stress fractureStress fracture CallusCallus Freiberg's Freiberg's
infractioninfraction CapsulitisCapsulitis Bone tumorBone tumor Local manifestation Local manifestation
of systemic diseaseof systemic disease
Morton’s Neuroma TreatmentMorton’s Neuroma Treatment
Change shoe gearChange shoe gear PaddingPadding OrthoticOrthotic Cortisone injectionCortisone injection 4% dehydrated 4% dehydrated
alcohol injection for alcohol injection for neurolysisneurolysis
Surgical excisionSurgical excision
Diabetic ulcerDiabetic ulcer
Etiology is usually Etiology is usually traumatic caused by traumatic caused by shoesshoes
Bony promonence is Bony promonence is usually involved usually involved (hammertoe, bunion, (hammertoe, bunion, plantarflexed plantarflexed metatarsal, bone spur)metatarsal, bone spur)
Often start as a Often start as a blister, corn or callousblister, corn or callous
Diabetic ulcer treatmentDiabetic ulcer treatment Always obtain serial X-rays Always obtain serial X-rays
to rule out osteomyelitisto rule out osteomyelitis Debride the wound to Debride the wound to
granular bedgranular bed Remove hyperkeratosisRemove hyperkeratosis Gently probe wound for Gently probe wound for
deep sinusdeep sinus Dress initially with Dress initially with
Silvadene creamSilvadene cream Consider other wound Consider other wound
productsproducts Consider offloadingConsider offloading
Charcot JointCharcot Joint Diabetic Diabetic
NeuroarthropathyNeuroarthropathy Often involves both Often involves both
pathologic dislocation pathologic dislocation and fractureand fracture
Usually effects Usually effects midfoot, but all lower midfoot, but all lower extremity joints are extremity joints are susceptiblesusceptible
Foot is acutely Foot is acutely edematous and warmedematous and warm
Deformity is commonDeformity is common
Charcot Joint TreatmentCharcot Joint Treatment
Non-weight bearing Non-weight bearing for 12 weeksfor 12 weeks
Patient education is Patient education is critical to outcomecritical to outcome
Serial X-rays to Serial X-rays to document deformitydocument deformity
Molded shoe often Molded shoe often needed after needed after coalescencecoalescence
Surgical TreatmentSurgical Treatment
Therapeutic ShoesTherapeutic Shoes
Newly diagnosed + Newly diagnosed + 33% 1990’s33% 1990’s
Amputations + Amputations + 28% 2000 -200128% 2000 -2001
Medicare has Medicare has stated that 50% of stated that 50% of amputations were amputations were preventablepreventable
Therapeutic ShoesTherapeutic Shoes
Focal pressure keratosis with Focal pressure keratosis with accompanying risk factors are the major accompanying risk factors are the major cause of ulcer.cause of ulcer.
Patients who have regular, frequent foot Patients who have regular, frequent foot clinic visits that include risk evaluation, clinic visits that include risk evaluation, debridement of lesions, prescription of debridement of lesions, prescription of appropriate shoes and patient education appropriate shoes and patient education are less likely to ulcerate. 1are less likely to ulcerate. 1
1 Sage RA, Webster JK, Fisher SG: Outpatient Care and Morbidity Reduction in Diabetic Foot Ulcers Associated with Chronic 1 Sage RA, Webster JK, Fisher SG: Outpatient Care and Morbidity Reduction in Diabetic Foot Ulcers Associated with Chronic Pressure Callus. JAPMA Pressure Callus. JAPMA 9191:275, 2001.:275, 2001.
Thank You!Thank You!