Flashcards in Lecture 3 Deck (82)
Corns vs callouses?
Corns are on the toe
Callouses are everywhere else
Hyperkeratotic lesion of the skin that forms in response to excessive pressure over a bony prominencde
What is a persistent callous on the sole of the forefoot?
intractable plantar keratosis
What type of callouses get referred to ortho?
None, “don’t send these to me, I will not be happy”
Thickening of the tissue around a nerve leading to the toes
Callouses beneath the metatarsal heads cause this
What causes callouses to hurt?
The callus itself or some other manifestation of chronic overload of the metatarsal head
What will usually cause corns?
- hammer toe
- claw toe
And tight footwear
Hard corns occur over bony prominences
Soft corns between the toes (webbed space)
Where do plantar warts present?
In the soft tissue, Not over bony prominences
How are corns and calluses treated?
Shaving with a scalpel to remove enough avascular keratin to restore normal contour to skin w/o drawing blood
Treatment for metatarsalgia?
Paring of the callous and correcting the problem that caused it to grow in the first place
What is a later stage tx for corns and callouses?
You can do surgical tx to remove underlying bone
Tx for plantar warts?
Topical salicylic acid
If that fails, surgery
What causes plantar warts?
They are hyperkeratotic lesions caused by human papillomavirus
Medical description of plantar warts?
Painful, slightly raised lesions on the sole of the foot.
What are clusters of plantar warts?
Differentiating plantar warts from callouses and corns?
- Non wt bearing areas
- Tender when pinched from sides
- tender w direct pressure
What will superficial paring of a wart with a scalpel reveal?
Punctate hemorrhage and a fibrillated texture
What if i really want to know what the shit growing on the foot is?
Why are aggressive tx of plantar warts not preferred?
Most spontaneously resolve w/in 6 months
What will improve the effectiveness of the keratolytic agents?
Occlusive tape (duct tape)
Besides tape what else will get rid of plantar warts?
Necrosis of the deep dermis?
You were too aggressive with the wart tx and now your pt has intractable painful scarring of the sole of the foot
What are some other risks for plantar warts?
They can spread to other areas of the foot
Secondary infection from your ablation efforts
Who gets referrals for persistent or recurring warts?
NOT AN ORTHO PROBLEM
Common culprit causing onychomycosis?
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
Common presentation of onchymycosis?
Discoloration, thickening and difficulty in trimming nail
Thickening and chalk yellow or white discoloration of the nail