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PHAY0010 > Foot care [completed] > Flashcards

Foot care [completed] Flashcards

1
Q

What is athlete’s foot?

A

Athletes foot or tinea pedis is a fungal skin infection of the foot

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2
Q

What are the most common fungi responsible for athlete’s foot?

A

Trichophyton rubrum
T. interdigitale
Epidermophyton floccosum (less common)

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3
Q

Is athletes foot more common in men or women?

A

TWICE as common in men

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4
Q

What age group is athletes foot most common in?

A

Adults aged 15-40
Risk increases with age.

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5
Q

What are some risk factors for developing athletes foot?

A
  • Having damp feet
  • Walking barefoot in communal areas
  • Sharing bed linen, towels or shoes with an infected person
  • Immunocompromised
  • Working in hot, humid climates or in high temperatures
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6
Q

What are the symptoms of athletes foot?

A

Itchiness/redess between toes
Dry flaky skin
maceration (skin is white and soggy)
Splitting/fissures
Burning, inflammation and pain
Unpleasant smell

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7
Q

What is usually the first symptom to occur in athletes foot?

A

A rash between the 4th and 5th toe.

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8
Q

Is athletes foot superficial?

A

Yes

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9
Q

Why does athletes foot need to be treated quickly?

A

Can spread to the soles and sides of the foot as well as the nailbeds (ONYCHOMYCOSIS)

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10
Q

What is moccasin-type athletes foot?

A

Affects the whole sole and sides of feet. sole is covered in silvery fine scales and skin is inflamed.

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11
Q

Most patient with moccasin-type athletes foot will also have….

A

onychomycosis

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12
Q

Why does mocassin-like athletes foot need to be referred to the GP?

A

Usually resistant to topical antifungals

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13
Q

What is vesicular/vesicubullous-type athletes foot?

A

Small hard blisters on the instep/arches and soles of feet due to an allergic reaction to the fungal infection.

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14
Q

What should we do if a patient presents with vesicular/vesicobullous athletes foot

A

Refer when severe.

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15
Q

Terbinafine 1% cream for athletes foot

A

Licensed in 12+ only
Apply thinly to the affected area once or twice a day for up to 7 days.

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16
Q

Clotrimazole 1% cream for athletes foot

A

Apply to the affected area 2–3 times a day and continue for at least 4 weeks. A strip of cream about half a centimetre long is enough to treat an area about the size of the hand.

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17
Q

Miconazole 2% cream for athletes foot

A

LICENSED IN ADULTS AND CHILDREN
Apply to the affected area twice a day for 2–6 weeks depending on the severity of the lesions, and continue for 10 days after all skin lesions are healed.

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18
Q

Econazole 1% cream

A

Apply to the affected area twice a day and continue until all skin lesions are healed.

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19
Q

What drug interaction IS RARE with topical miconazole and econazole?

A

Oral anticoagulants as antifungals are being applied topically. Use with caution

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20
Q

When may hydrocortisone 1% cream be supplied?

A

If there is an associated marked inflammation and no other contraindications - to be applied ONCE DAILY FOR SEVEN DAYS
THEN SWITCH BACK TO JUST ANTIFUNGAL

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21
Q

What treatments are not recommended in athletes foot?

A

Tea tree oil

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22
Q

How can athletes foot be prevented?

A

Wash feet regularly and dry thoroughly especially between toes
Wear sandals in communal areas
Keep feet dry and cool
Wear cotton socks and change them regularly
Do not wear tight fitting occlusive shoes for long periods of time
Change shoes every 2-3 days
Antifungal powders can be put into shoes
Keep toenails clean and short
Do not scratch infected areas - wash hands after touching
Do not share towels and wash them frequently

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23
Q

What is a verruca?

A

Wart at the bottom of the foot or on toes with a black dot in the middle.

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24
Q

What are veruccas caused by?

A

HPV

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25
Q

How may a verruca feel when patient walks?

A

Pressing, sharp pain

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26
Q

Does a verucca always have to be treated?

A

No as they can resolve spontaneously although this can take up to 2 years with most patients and 5-10 years for some.

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27
Q

What is the common active ingredient in many verucca treatments?

A

Salicylic acid

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28
Q

Name some salicylic acid containing products?

A

Duofilm
Bazuka
Salactol
Scholl medicated plasters

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29
Q

Who should not use topical salicylic acid?

A

Children under 2
Children or teenagers who have just had a viral infection

Topical salicylic acid should not be used on:
The face.
Intertriginous or anogenital regions.
Moles or birthmarks.
Mucous membranes.
Warts with hair growing out of them, red edges, or an unusual colour.
Open wounds, irritated or reddened skin, or any area that is infected.
Areas of poor healing, such as neuropathic feet, or in those with impaired blood circulation.

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30
Q

Topical salicylic acid should not touch healthy skin as it can cause burning. How can this be avoided?

A

Applying a thin layer of vaseline around the verucca to protect the skin.

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31
Q

Salactol contains lactic acid. What does this do?

A

Softens the skin of the verucca

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32
Q

How is topical salicylic acid applied to veruccas?

A

Usually once a day at night
Debride verucca with emery board and soften skin by soaking in warm water
Peel off any film from the previous application
Protect surrounding area with vaseline

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33
Q

What reactions may topical salicylic acid cause?

A

Chemical burns
Skin irritation
Allergic dermatitis
Skin discolouration

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34
Q

What is cryotherapy?

A

When the verucca is frozen off using liquid nitrogen by a healthcare professional.

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35
Q

How many cycles of cryotherapy will a person need?

A

Differs from person to person but usually every 2-3 weeks up to 6 cycles.

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36
Q

Who should not receive cryotherapy?

A

People with an uncertain diagnosis or a possible malignancy.
Young children (who may find it too painful).
Distal extremities in people with:
Raynaud’s syndrome.
Peripheral vascular disease.
Peripheral neuropathy.
Periungual sites — this is painful and there is a risk of subungual haemorrhage and nail deformity.
For warts that are over tendons or near superficial nerves

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37
Q

Over the counter cryotherapy such as Wartner and School freeze can be used in which age groups?

A

4+ as long as there are no other contraindications

38
Q

What is not recommended in treating veruccas and why?

A

Duct tape as there is no evidence for it and it can irritate the skin further

39
Q

What is onychomycosis?

A

Fungal nail infection that can affect any part of or all of the nail

40
Q

Does onychomycosis develop slowly or quickly?

A

Slowly

41
Q

What happens to the appearance of the nail as onychomycosis develops?

A

Nail will be discoloured
Nail plate distorts
Nail bed and tissue around it may thicken

42
Q

Why may people not want to get treatment for nail infections?

A

Embarassing

43
Q

Why do fungal nail infections more commonly affect toe nails compared to fingernails?

A

Toe nails grow slower
Reduced blood supply
Dark moist conditions when wearing shoes and socks

44
Q

Does onychomycosis affect men or women more?

A

men

45
Q

True or false. Onychomycosis can spread from getting pedicures if there is not appropriate hygiene measures.

A

True

46
Q

Does onychmycosis affect younger or older people more?

A

older

47
Q

What types of organisms are commonly responsible for fungal nail infections?

A

Dermatophyte and non-dermatophyte moulds
Candida

48
Q

What are the most common causative agents for onychomycosis? (85-90% of cases)

A

Dermatophyte fungal infections:
T.rubrum
T.interdigitale

49
Q

What are some non dermatophyte moulds that can cause onychomycosis?

A

Aspergillus
Fusarium
Scopulariopsis
Scytalidium
Acremonium
(only 2-5% of toenail infections, fingernails are rare)

50
Q

Yeast (candida) infection is responsible for 5-10% on onychmycosis cases. Where do candida nail infections commonly occur?

A

Fingernails

51
Q

Why are candida infections of the nails difficult to eradicate?

A

Very resistant to treatment

52
Q

What is the main drug treatment for onychomycosis?

A

Amorolfine 5% Nail lacquer (Curanail)

53
Q

After confirming fungal (dermatophyte or candidiasis) infection of the nail, topical antifungals would be reccomended in adults if….

A
  • up to 50% of nail plate is involved with no nail matrix involvement
  • up to two affected nails
  • early, or mild onychomycosis that starts at the end of the nail
  • superficial white onychomycosis
  • oral antifungals are contraindicated
54
Q

How often is amorolfine 5% nail lacquer applied?

A

Once or twice a week for 9-12 months in toe nails or 6 months in fingernails

55
Q

How does amorolfine work?

A

Applied like nail polish to nail
Solvent evaporates leaving a concentrated deposit of amorolfine in an occlusive film on nail
Amorolfine can then diffuse through the nail plate over 7 days.
It then can inhibit the synthesis of ergosterol disrupting the fungal cell well - cell death.

56
Q

What are corns?

A

Bubbles of hardened skin that form on feet area.

57
Q

What are calluses?

A

Large patches of rough skin that develop on the bottom of the feet

58
Q

What is some self-care advice that can be given to a patient with corns or calluses?

A

Wear thick cushioned socks
Wear comfortable shoes that don’t rub
Wear soft insoles or heel pads
Avoid being barefoot
Soak feet in warm water and file down gently using foot file or pumice stone
Do not try to cut them off
Avoid walking long distances or standing for long periods of time

59
Q

What products are avaialble from pharmacies to heal thickened hard skin of the feet?

A

Rehydration creams which moisturise and break down thickened skkin
Customised soft padding or insoles
Foam wedges to place between toes to help relieve soft corns
Silicone wedges that can change the position of the toes and redistribute pressure
Protective corn plasters

60
Q

When should we refer corns and calluses?

A

Often not serious but should referred if diabetes, CVD or any conditions that can affect circulation
Refer to GP if there is a possible underlying infection

61
Q

What can a podiatrist do after a patient is referred to them with corn and calluses?

A

Can remove them without damaging surrounding tissues.

62
Q

Why should patient be careful before using corn plasters?

A

They contain salicylic acid which can burn healthy skin. Patients should speak to a podiatrist before using them.

63
Q

What is a blister?

A

A small pocket of fluid that usually forms in the upper layers of skin after damage. The fluid cushions the tissue underneath it to protect it from further damage and allow healing

64
Q

Blister are usually filled with a clear fluid (serum) but can also be filled with…

A

blood or pus if they become infected or inflamed

65
Q

What are some causes of blisters?

A

Ill-fitting shoes
Stiff shoes
Wrinkled socks against the skin
Excessive moisture
Foot deformities

66
Q

Do most blisters require medical attention?

A

No most of them heal naturally after 3-7 days if further friction is avoided

67
Q

Why should blisters not be popped?

A

Can lead to infection and slow down the healing process

68
Q

How can a blister be protected?

A

Cut a hole in a piece of foam or felt to form a doughnut over the blister.Tape the doughnut or cover using a soft gel-type dressing

69
Q

How should open blisters be treated?

A

Mild soap and water. Then apply an antiseptic ointment like savlon or germolene and a soft protective dressing to prevent infection and speed up the healing process

70
Q

Hydrocolloid dressings are available in pharmacies for blisters. What do they do?

A

Prevent discomfort and encourage healing

71
Q

How often should dressings be changed for blisters?

A

Daily and person should wash hands before and after touching the affected area.

72
Q

What is an ingrown toenail?

A

A common problem where the nail grows into itself.
Red, painful and pressure around the nailbed area. which can lead to infection The toenail curves into itself
Discharge may be present

73
Q

How can a patient manage an ingrown toenail?

A

Soak foot in warm water 2-4 times a day for a few days to soften skin.
Dry feet and wear comfy shoes
Take OTC paracetamol and ibuprofen
Do not cut the nail or pick at or break skin

74
Q

When should an ingrown toenail be referred?

A
  • Diabetic
  • Very swollen or painful
  • infection : pus/discharge
  • over 4-5 days and getting worse
    Fever, high temp
75
Q

What causes dry and cracked heels

A

Lack of moisture in the skin which can be worse if the person wears open backed shoes and doesn’t drink enough water

76
Q

Which groups are particularly prone to sweaty, odorous feet?

A

Teenagers and pregnant women due to hormonal changes

76
Q

How can we treat and prevent dry cracked heels?

A
  1. File the hard skin once or twice a week when it is dry
  2. Moisturise feet with a thick moisturising cream everyday after a bath or shower such as Flexitol or Compeed
  3. Consider wearing stocking or closed shoes to keep moisture in
  4. Continue to moisturise feet daily even when skin is better.
77
Q

How can a person manage foot odour?

A
  1. Wash feet every morning and night with warm soapy water
  2. Change socks at least once a day
  3. Use an antibacterial wash and then wipe with cotton wool soaked in surgical spirit to remove odour-causing bateria
  4. May be able to use medicated insoles (neutralises shoe odour) and sprays.
78
Q

What percentage of the population are likely to experience venous leg problems in their lifetime?

A

50%

79
Q

Why do so many people experience venous leg problems?

A

Due to gravity pushing blood away from heart and into legs the pooling of blood makes the legs feel tired.

80
Q

What should people who stand all day do to improve circulation?

A

Move around regularly or flex their legs up and down

81
Q

What can help to ease tired aching legs?

A

Putting feet up and keeping the legs uncrossed for long periods of time.

82
Q

What footwear is important in easing or preventing tired aching legs?

A

Patients should wear supportive trainers and vary heel heights during the day.

High heels can be linked to aching legs

83
Q

List FOUR general footsore tips.

A

Wear the right footwear
Allow proper blood circulation
Keep feet clean and dry
Maintain toenails

84
Q

When would we refer foot conditions?

A

Diabetes
Loss of feeling in feet or toes
Bleeding in feet or toes
Signs of bacterial infection: pus, pain, swelling, tenderness, heat
Poor mobility

85
Q

What is diabetic neuropathy?

A

High blood glucose levels causes damage to the nervous system especially in longer nerves in feet and legs?

85
Q

Why is blood circulation impaired in diabetes?

A

Blood vessels can be damaged?

86
Q

What can happen in injuries or hard skin in the feet of diabetic people?

A

Can become more serious conditions and damage can take longer to heal.

87
Q

What can happen if the feeling in the feet is lost in diabetic people and they get an injury?

A

They won’t know they have an injury –> are not treated in time –> condition becomes severe –> may have to get amputation

88
Q

What are some tips to help diabetic patients keep their feet healthy?

A
  1. Go to yearly foot check
  2. Look at your feet everyday
  3. Try not to go barefoot
  4. be careful cutting the nails
  5. Do not use corn removing plasters or blades
  6. Wear well-fitting shoes and socks

PHAY0010 (27 decks)

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