21: Mechanical/Biomechanical Skin Lesions - Bennett Flashcards
1
Q
causes of hyperkeratosis
A
- Mechanical stresses (improper or poorly fitting shoes) - Abnormal foot mechanics (bony or biomechanical deformities) - High levels of activity
2
Q
what is a diffuse shearing callus?
A
- Weight bearing surface of the sole - Usually asymptomatic - Pain if they dry and fissure - Even thickness, undefined margins - Related to abnormal shearing/friction forces - Treatment = control abnormal pronation, tissue debridement, surgery
3
Q
what is a discrete nucleated callus?
A
- Usually isolated
- Painful
- Central conical core of keratin at greatest pressure
- Can often be confused with plantar’s wart
- Plantar warts are more sensitive to side-to-side compression, whereas this callus causes pain with directed pressure
4
Q
porokeratosis plantaris discreta
A
- 1-3 mm punctate lesion
- Weight bearing aspect of sole
- Direct pressure from plantar surface
- Sweat duct involvement
- Hyperkeratosis of epidermal sweat duct
- No vascular involvement
- Can be as deep as 1.5 cm
5
Q
treatment for porokeratosis
A
- Topical keratolytics (urea cream 20%)
- Periodic debridement
- Alcohol sclerosing injections (destroys the sweat duct)
- Surgical excision of the lesions
6
Q
describe a superficial shearing callus
A
- Shallow nucleus or no nucleus
- Usually asymptomatic
- Debridement
- Skin lines visible underneath (warts have skin lines around lesion)
7
Q
describe a superficial fibrous shearing callus
A
- Clear keratin nucleus with white fibrous base that blends into surrounding callus
- Painful when hypertrophic
- Debridement
8
Q
describe a fibrous nucleated shearing callus
A
- Deep nucleus with white fibrous plug
- Clearly differentiated margin
- Enucleation painful
- Must remove plug to get relief
- Treatment = Debridement, Curettement, Bone surgery
9
Q
common callus affecting the hallux due to unstable hallux during propulsive phase of gait
A
pinch callus
10
Q
why have a callus plantar to the first met head ?
A
- Plantarflexed 1st ray
- Enlarged or multiple sesamoids
11
Q
why have a callus plantar to second and third met head?
A
- Hypermobile first ray
- Hallux abducto valgus deformity
- Plantarflexed metatarsal
12
Q
why have a callus plantar to fourth met?
why have callus plantar to fourth and fifth met heads?
A
- Hypermobile 5th ray
- Plantarflexed 4th ray
- Supinated foot type
- Cavus (rigid) foot type
13
Q
why have a callus plantar to the hallux IPJ?
A
- hallux limitus
- IPJ sesamoid
14
Q
heloma =
A
Corn
15
Q
describe heloma durum
A
- Dense compacted tissue
- Areas of pressure on toes
- Example – lateral aspect of the 5th toe
- May appear dry or waxy
- Conical
- Tx: periodic debridement, topical keratolytics, fix underlying bone pathology, shoe gear modification, padding