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P-2 Ortho 3 > Lecture 3 > Flashcards

Lecture 3 Flashcards

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1
Q

Corns vs callouses?

A

Corns are on the toe

Callouses are everywhere else

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2
Q

Callous definition?

A

Hyperkeratotic lesion of the skin that forms in response to excessive pressure over a bony prominencde

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3
Q

What is a persistent callous on the sole of the forefoot?

A

intractable plantar keratosis

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4
Q

What type of callouses get referred to ortho?

A

None, “don’t send these to me, I will not be happy”

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5
Q

Metatarsalgin?

A

Thickening of the tissue around a nerve leading to the toes

Callouses beneath the metatarsal heads cause this

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6
Q

What causes callouses to hurt?

A

The callus itself or some other manifestation of chronic overload of the metatarsal head

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7
Q

What will usually cause corns?

A

Toe deformities:

  • hammer toe
  • bunionette
  • claw toe

And tight footwear

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8
Q

Heloma durum?

A

Hard corns occur over bony prominences

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9
Q

Heloma molle?

A

Soft corns between the toes (webbed space)

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10
Q

Where do plantar warts present?

A

In the soft tissue, Not over bony prominences

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11
Q

How are corns and calluses treated?

A

paring:

Shaving with a scalpel to remove enough avascular keratin to restore normal contour to skin w/o drawing blood

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12
Q

Treatment for metatarsalgia?

A

Paring of the callous and correcting the problem that caused it to grow in the first place

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13
Q

What is a later stage tx for corns and callouses?

A

You can do surgical tx to remove underlying bone

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14
Q

Tx for plantar warts?

A

Topical salicylic acid
or
liquid nitrogen

If that fails, surgery

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15
Q

What causes plantar warts?

A

They are hyperkeratotic lesions caused by human papillomavirus

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16
Q

Medical description of plantar warts?

A

Painful, slightly raised lesions on the sole of the foot.

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17
Q

What are clusters of plantar warts?

A

“Mosaic warts”

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18
Q

Differentiating plantar warts from callouses and corns?

A

Plantar warts:

  • Non wt bearing areas
  • Tender when pinched from sides

Corn:
- tender w direct pressure

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19
Q

What will superficial paring of a wart with a scalpel reveal?

A

Punctate hemorrhage and a fibrillated texture

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20
Q

What if i really want to know what the shit growing on the foot is?

A

Histopathologic examination

Seldom necessary

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21
Q

Why are aggressive tx of plantar warts not preferred?

A

Most spontaneously resolve w/in 6 months

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22
Q

What will improve the effectiveness of the keratolytic agents?

A

Occlusive tape (duct tape)

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23
Q

Besides tape what else will get rid of plantar warts?

A

Electrocautery
Cryotherapy
Laser ablation
Curettage

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24
Q

Necrosis of the deep dermis?

A

You were too aggressive with the wart tx and now your pt has intractable painful scarring of the sole of the foot

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25
What are some other risks for plantar warts?
They can spread to other areas of the foot Secondary infection from your ablation efforts
26
Who gets referrals for persistent or recurring warts?
NOT AN ORTHO PROBLEM
27
Common culprit causing onychomycosis?
Trichophyton rubrum T. Mentagrophytes Cause 90%
28
Why do we care about fungal infections of the toe?
Primarily cosmetic but sometimes nail becomes hypertrophic and interfers with foot wear So we care because our pt cares
29
Common presentation of onchymycosis?
Discoloration, thickening and difficulty in trimming nail Thickening and chalk yellow or white discoloration of the nail
30
What cements the nail fungus diagnosis?
Microscopic exam of the nail scrapping on KOH wet prep
31
What meds are useful in treating nail fungus?
Itraconazole Fluconazole Ketoconazole Terbinafine
32
What do you do with persistent or recurring fungus?
These are common NOT AN ORTHO PROBLEM
33
Onychocryptosis?
Ingrown toenail
34
What is pincer nail deformity?
Transverse over curvature of the nail | Can be hereditary or acquired
35
When should ingrown toenails get x-rayed?
Not usually used May order to evaluate for subungal exostosis and osteomyelitis
36
Tips and tricks to help with ingrown toenail removal?
You can shove cotton under it if it isnt bad and not cut them Soak x 20 min in epsom salt presurg Corticosteroids may help
37
What if you keep removing a toenail and it keeps coming back?
Nail ablation Chemical matrichectomy (phenol)
38
When all else fails with ingrown toenails?
Refer to podiatry
39
What is turf toe?
Hyperextension injury to the hallux metatarsophalageal (MTP) joint Usually the 1st MTP
40
What will you often see with x ray of bad turf toe?
Proximal sesamoid mitration/retraction
41
What is the treatment for turf toe?
He had a big chart that broke down the grades and the tx He said “just know that they do great with nonoperative tx (rest)”
42
Where are the sesamoid bones (foot)
Embedded in the flexor hallucis brevis tendon Beneath the first metatarsal head (plantar surface)
43
What is included in sesamoid disorders?
Inflammation Fracture Osteonecrosis Arthritis
44
What causes seasmoiditis?
Repeated stress of the sesamoid and subsequent inflammation
45
What will sesamoiditis look like (pt presentation)
Pain under first metatarsal head With our without swelling or ecchymosis And they are usually big runners or dancers
46
What will PE show for seasmoiditis?
Same for itis and fx Focal tenderness at sesamoid bone Pain w toe dorsiflexion Tender spot moves w sesamoid as the great toe is flexed or extended
47
X ray for sesamoiditis?
AP, Lateral and axial Oblique may be helpful too
48
What is often confused with fractured sesamoids?
Bipartitie or multipartite seasmoid bones 25% of the population has them Normal variant
49
How to differentiate between bipartite or multipartite and sesamoid fx?
Normal variants have smooth margins and fx have sharp margins Compare with other foot if needed
50
What therapy should be done for sesamoiditis?
Tell them to not wear high heels You can also: - tape in plantar flexion - sesamoid pads - stiff-soled or rocker bottom shoe - removable short leg fx brace x 4-6 weeks
51
What if the nonoperative therapy doesnt work for sesamoiditis?
Excision of the sesamoid
52
What are the deformities of the lesser toes?
Hammer toes Claw toes Mallet toes
53
What is a claw toe?
Fixed extension of MP and flexion PIP joint
54
What is a common cause of claw toe?
Secondary to a neurologic disorders - charcot-marie-tooth - inflammatory arthritis (RA)
55
What is a hammer toe?
Correctable extension of MTP and flexio deformity of PIP | No significant deformity of DIP
56
What is mallet toe?
Flexion deformity a the DIP joint Normal PIP and MP joints
57
What causes hammer toes and mallet toes?
Improper shoe wear
58
What toe deformities need neurologic workup?
Claw toes | High arch
59
What can pts with toe deformities do to make their life better?
Have a cobbler stretch the toe box of their shoes
60
What is the goal of surgery for toe deformities?
Not cosmesis but alignment of the toes so they can comfortably accommodate footwear
61
For toes and also in general who makes poor candidates for surgical treament?
Pts with Vascular insufficiency
62
Differentiating claw, hammer and mallet toe?
Claw: fixed ext of MTP Hammer: correctable ext of MTP/fixed flexed PIP Mallet toe: normal MTP/PIP. Fixed flexed DIP
63
What is the primary etiology for diabetic foot?
Loss of protective sensation, Autonomic dysfunction, Motor impairment
64
What predisposes the diabetic foot to ulceration?
Autonomic dysfunction leading to dry, scaly and cracking skin
65
Why is motor neuropathy in the feet a problem for diabetics?
``` It leads to weakness of the intrisic muscles of foot leading to deformaties which: Increse pressure on foot -> skin breakdown, ulcers, deep infections and osteomyelitis ```
66
Charcot neuropathy results in?
Progressive disruption of joint stability and severe bony deformities
67
Early charcot is often misdiagnosed for?
Cellulitis, osteomyelitis or gout B/c often presents with warmth, erythemia
68
Stages of charcot?
Stage 0: normal rads with inflammation Stage 1: fragmentation and osteopenia Stage 2: coalescence w/ decreased Stage 3: reconstruction, no inflammation
69
Does diabetic foot hurt
No But they may have foot pain at night described as burning and tingling
70
What is a key element of the exam for diabetic foot problems?
Through evaluation is important and they cant feel it so get in there and check it out
71
Why do we need to take preventative measures and early tx seriously?
Can often prevent amputations
72
What do pts who cannot feel 10-g, 5.07mm nylon filament on the plantar aspect of the foot need?
Protective foot care and well-coushioned shoes
73
How accurate is the monofilament test?
97% sensitive | 83% specific
74
What is a warning sign for osteomyelitis?
If you can probe the bone
75
Who gets a vascular study (diabetic foot)?
Appropriate when pulses are absent or when pt has non-healing ulcer
76
What about the fancy radiology for diabetic foot
MRI can be helpful but not usually necessary Combined technetium-iridium bone sans have been used in difficult cases to differentiate charcot arthropathy from osteomyelitis
77
Are neuropathy reversible?
No
78
Should you do skin swab cultures of diabetic foot ulcers
They are inaccurate | Bone biopsys are preferred
79
Are abscesses on diabetic feet a big deal?
Any abscess should be considered an emergency and drained time now
80
What is often required once osteomyelitis is present?
Digit or ray (toe + metatarsal) amputation often necessary
81
Your pt has diabetic foot what do they win?
Rainbow of consults - dietician - podiatry - ophthalmology - orthopedic surgery (charcot or diabetic foot)
82
Dear frozen yogurt. You are the celery of deserts
Be ice cream or be nothing. Zero stars | - ron swanson

P-2 Ortho 3 (6 decks)

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