Podiatry in Practice. Alan M. Singer, DPM, FACFAS

Transcription

1 Podiatry in Practice Alan M. Singer, DPM, FACFAS

2 Podiatry in Practice Alan Singer, D.P.M. UNIVERSITY PODIATRY GROUP

3 Onychomycosis

4 Anti-fungals

5 Onychocryptosis (Ingrown Nails)

6 Ingrown Nails

7 Partial Nail Avulsion

8 Partial Nail Avulsion

9 Matrixectomy

10 Wart

11 OTC Wart Removal

12

13 Bleomycin

14 Intractable Plantar Keratoma

15

16 Foreign Body

17 Common Forefoot Deformities Soft Tissue Neuromas Ganglions, synovial cysts and other soft tissue lesions Osseous Digital Deformities Lesser metatarsalgia Tailor s bunion First ray deformities (bunion, hallux limitus)

18 Neuroma

19 Neuroma

20 Ganglion Cyst

21 Hallux Abducto Valgus & Hammertoe

22 Bunion

23 Pre-Op Hallux Valgus

24 Post-Op Hallux Valgus

25 Hammertoes

26 Anatomy of a Hammertoe

27 Hallux Limitus

28 Joint Implants

29 Stress Fractures Bone healing after stress fracture Non-diagnosed stress fracture

30 Heel Spur

31 Orthotics

32 Gout

33 The Diabetic Foot:

34 Key Factors Neuropathy Decreased sensation MOST important factor Poor Circulation Decreased Immune Response Foot deformities Trauma

35 Diabetic Neuropathy Loss of sensation or alteration in sensitivity to feet and legs Sometimes painful (i.e. burning or shooting pains particularly at night) Decreased ability to feel PAIN Compromises ability to recognize injuries to foot Muscle weakness hammertoe formation Dermatologic skin changes

36 Poor Circulation Reduced blood flow to feet Compromises adequate delivery of oxygen and nutrients to feet Symptoms Temperature and color changes Loss of hair and thickening of toenails Cramping in calves with walking Treatments

37 Infection High sugar levels impair ability of white blood cells to fight infection Diabetic infections can become serious very quickly IMPORTANT to diagnose and treat early Infection will increase sugar levels and often give flu-like symptoms Infection is the most common reason for hospital admissions in diabetics

38 Foot Deformities Bunions, hammertoes, metatarsal deformities increase risk for developing pressure lesions Charcot arthropathy Collapse of insensate foot causing marked swelling and widening Increased warmth NEED to protect

39 Diabetic Ulcers Usually painless in the diabetic Usually caused by trauma: Heat Cold Pressure (i.e. shoes) Penetration by foreign object Most commonly repetitive microinjuries

40 Diabetic Ulcers Often preceded by corn or callus Develop into ulcers due to neuropathy Absence of natural alarm system Continued pressure creates further damage Ischemia (poor blood flow) prevents normal healing of the wound

41 Diabetic Ulcers

42 Diabetic Ulcers

43 Diabetic Ulcers

44 Treatment of Diabetic Ulcers Debridement Cleaning or cutting away of callus or necrotic tissue in or around wound Local wound care Topical growth factors Wound care ointments & antibiotics Vascular reconstruction Off-weighting of lesion

45 Diabetic Ulcer Treatment

46 Team approach Podiatrist Internist or endocrinologist Cardiologist Diabetic educators Vascular surgeons Pedorthotist

47 Footwear Comfortable shoes Shoes are meant to PROTECT, not to hurt Adequate width and depth If it is hard to slip on, do not wear it Leather shoes preferable Adapt to shape of foot Allow feet to breathe

48 Footwear Athletic shoes are good choice Custom molded or extra depth shoes Important for difficult or unusually shaped feet Special insoles or custom orthotics Do NOT walk barefooted Neoprene aquatic shoes Avoid open-toed shoes or sandals

49 Footwear ALWAYS check shoes for foreign objects before putting them on Try to wear two or three different shoes during a day Wear new shoes only for a few hours at a time initially, checking for areas of irritation Socks should be well-fitting without seams or folds

50 Taking Care of Your Feet Keep blood sugars under control Wash feet daily and dry carefully in between toes Check feet daily for sores, calluses, red spots, cuts, swelling, and blisters If difficult to see use a mirror or ask for help Do not put feet into hot water Always check water temperature with fingers

51 Taking Care of Your Feet When feet are cold, use socks Do not using heating pads or hot water bottles Do not wear garters or very tight socks Can cut off blood supply Do not use over the counter chemicals for corns, calluses or warts Cut toenails straight across and file edges

52 Taking Care of Your Feet Wear flat shoes that fit the feet Break in new shoes slowly ALWAYS look inside shoes before putting them on NEVER walk barefoot Keep slippers at bedside DO NOT SMOKE DO NOT perform bathroom surgery

53 Websites American Podiatric Medical Association American Diabetes Association ody_care/foot/foot_care.jsp

54 Thank THE You END For Your Attention Alan Singer, DPM UNIVERSITY PODIATRY GROUP