Crozer- Clinical Podiatry Flashcards
clinical patterns of tinea pedis? common infecting org?
chronic (moccasin/papulosquamous-trichophyton rubrum
acute (interdigital/vasicular)-trichophyton mentagrophytes
Ulceration-trichophyton mentagrophytes w pseudomonas or proteus
patterns of onychomycosis? infecting org?
Distal subungual onychomycosis (DSO) ~ 90%
Most common
Trichophyton rubrum
Proximal subungual onychomycosis (PSO) ~ 1%
Seen in immunocompromised patients
Trichophyton rubrum
Superficial white onychomycosis (SWO) ~ 10%
Trichophyton mentagrophytes
Candidal onychomycosis
Candida albicans
what test confirms tinea pedis or onychomycosis
KOH prep of skin/nail. septate
how does lamisil work
inhibits ergosterol syn
whats phenol
carbolic acid
if pt allergic to all locals what can you use during a nail avulsion?
Saline block (pressure block)
pressure cuff
benadryl block
causes of hallux varus
Congenital Clubfoot Metatarsus adductus Traumatic MPJ dislocation Fracture Iatrogenic Overcorrection of intermetatarsal angle Excessive resection of medial eminence or staking the head Fibular sesamoidectomy Overaggressive capsulorrhaphy Bandaging too far into varus
Staking the head
excessive resection of 1st met head-> varus
flexor stabilization hammertoes
Most common
Stance phase
Flexors overpower interossei
Pronated foot
extensor substitution
Swing phase
Extensors overpower lumbricals
Anterior cavus, ankle equinus, anterior compartment muscle weakness
Flexor substitution
Least common
Stance phase
Deep compartment muscles overpower interossei
Supinated, high arch foot or weakened Achilles
whats the silfverskiold test
Determines gastroc vs. gastroc-soleus
Positive test
Dorsiflexion of the foot to neutral or beyond with the knee in flexion
Gastroc equinus
Negative test
Lack of dorsiflexion of the foot to neutral with knee in flexion and in extension
Gastroc-soleus equinus
Lachman test
Determines if there is a plantar plate tear or rupture. While stabilizing the metatarsal, a dorsal
translocation of the proximal phalanx greater than 2 mm is suggestive of rupture.
Mulder sign
Identifies a Morton neuroma by a palpable click when compressing metatarsal heads and
palpating the interspace
sullivan sign
separation of digits caused by a mass in the interspace
q angle
btwn axis of the femur and the line between the patella and tibial tuberosity
edema with a cast. when to worry?
if down in AM know it is gravity edema.
if doesn’t go down=abnormal
Stages of raynauds?
white-> blue-> red
Pallor – spasm of digital arteries
Cyanosis – deoxygenation of blood pools
Rubor – hyperemia
ABI normal?
Ankle Brachial Index – compares ankle to arm pressures Normal 1 Intermittent claudication 0.6-0.8 Rest pain 0.4-0.6 Ischemic ulcerations <0.4
what may falsely elevate the ABI?
Vessel calcification/non compressible vessels
What other tests are typically performed with an ABI?
Segment pressures
Measured at high thigh, above the knee, below the knee, ankle, midfoot, and toe
Normal 70-120 mm Hg
Drop between segments >30 mm Hg indicate disease in vessel above
Pulse volume recordings (PVRs)
Normal waveforms are triphasic
Waveforms are widened and blunted with severe disease
most common skin cancer?
basal cell carcinoma
what skin cancer is cauliflower like
Squamous cell carcinoma
most common melanoma
superficial spreading melanoma- any part of body
most malignant melanoma
nodular melanoma- misdiagnosed as pyogenic granuloma
most benign melanoma
lentigo melanoma
type of melanoma of palms soles and nail beds
acral lentiginous melanoma
hutchinson sign
pigment changes in the eponychium seen w subungual melanoma
what conditions associated w plantar fibromatosis
ledderhose disease, dupuytren contraction, peyronie disease
another name for congenital convex pes valgus
vertical talus
radiographic findings of CCPV
calc in equinus, plantarflexed talus, dorsally dislocated navicular, increased TC angle
what additional radiographs for neonates with ccpv
lumbosacral films
What are three coalitions of the rearfoot?
talocal, calcnav, talonav
percent tarsal coalitions bilateral
50%
what coalliton is most symptomatic
CN
what coalliton is most asymptomatic
TN
what coalliton is most common
TC> CN>TN
which TC facet is most commonly fused
Medial > anterior > posterior
what are ages of fusion
T-N (3-5 years)
C-N (8-12 years)
T-C (12-16 years)
What are radiographic findings of tarsal coalitions?
Rounding of lateral talar process
Talar beaking due to increased stress on talonavicular ligament
Asymmetry of anterior subtalar facet
Narrowing or absence of middle and posterior subtalar facets
Halo sign – circular ring of increased trabecular pattern due to altered compressive forces
Anteater sign – C-N coalition in which calcaneus has elongated process on lateral view
Putter sign – T-N coalition in which neck of talus unites with broad expansion of
navicular
The anterior facet is best seen by which radiographic views?
med oblique, ischerwood
The middle and posterior facets are best seen by which radiographic view?
harris beath
what are tx for symptomatic tarsal coalitions
Orthotics or supportive therapy Immobilization NSAIDs Badgley – surgical resection of coalition or bar with interposition of muscle belly Isolated fusion or triple arthrodesis
What are the 3 components of clubfoot?
FF add, RF varus, ankle equinus
clubfoot what ligaments contracted?
Posterior Posterior tib-fib Posterior talo-fib Lateral calcaneofibular Syndesmosis Medial Superficial deltoid Tibionavicular Calcaneonavicular Talo-Navic, Navic-Cunei, and Cunei-1st MT joints Spring ligament
clubfoot What muscles/tendons are contracted?
Posterior Achilles tendon Plantaris tendon Medially PT, FDL, and FHL Abductor hallucis Anteriorly Tibialis anterior
what is technique for correcting clubfoot called
Ponseti technique
Serial casting
First correct the FF and RF deformities, and then correct ankle equinus
During manipulation, pressure is applied to the head of the talus (not the calcaneus)
4-8 casts, percutaneous Achilles tenotomy (last cast for 3 weeks), occasional TA transfer,
and D-B bar brace until age 3 y/o to prevent relapse
accepted theory about clubfoot
Germ plasma defect-malposition of head/neck of talus
simon rule of 15
For clubfoot, children <3 years → talo-navicular subluxation
T-C angle is <15° and talo-1st metatarsal angle is >15°
