Exam #2: Geriatric Foot Pathology Flashcards
What is xerosis?
Dry-skin
The loss of what protein is associated with dry skin in the elderly?
Filaggrin
*This protein binds keratin to macrofibrils
What are the four major causes of xerosis in the elderly?
- 15% decrease in eccrine sweat glands
- Loss of filaggrin
- Delayed recovery of stratum corneum
- ANS dysfunction
If a patient has tried numerous moisturizers, but they still have dry skin on his foot, what should you suspect? What test can you do to confirm?
Tenia pedis (athlete's foot) - KOH prep & look under microscope for hyphae
How can you treat xerosis?
Treat with a class of moisturizer from one of the following classes:
1) Lanolin
2) Water
3) Urea
4) Lactic acid
5) Oatmeal
+ hydrocortisone for redness (erythema)
What should you do if none of the OTC moisturizer’s works for your patient?
Saran wrap at night following a bath
**“Wet it, then lock in moisture”
How do you treat tinea pedis?
OTC Lamasil
What is ocychomycosis?
Fungal nail infection
What ezyme causes the classic signs of fungal nails?
Keratinase–breaks down keratin
What is the TOE CLYPT mnemonic for?
Causes of thick yellow nails
Outline “TOE CLYPT.”
Trauma Onychomycosis Eczema Circulatory problems Lichen planus Yellow nail syndrome Psoriasis Tumor
What is onychocryptosis?
In-grown toe nails
*Note that these are caused by heredity
When infection accompanies an in-grown nail, what is it called?
Paronychia
What can you assume paronychia infection is caused by?
S. aureus
How can you treat a paronychia conservatively?
- Soak & betadine
- Keflex (cephlexin 500 mg BID)
What is hyperkeratosis?
Thickened skin i.e. corn or callus that may hide deeper skin ulcerations
*pressure dependent
Why is hyperkeratosis potentially very dangerous?
Proximity of underlying ulcer to bone can lead to osteomyelitis
What is the conservative treatment for hyperkeratosis?
- Debridement
- Padding
- Shoe modifications
What is a bunion?
Prominent medial aspect of the 1st metatarasal head
**Note that this is a NORMAL 1st metatarsal
How are bunions treated?
SAS shoes
Bunion shield
Toe separator
Surgery
What is a hammertoe?
One phalanx that is dorsiflexed, and one that is plantarflexed
How do you treat hammertoes?
- Debride corns/ callous
- Pad
- Splint
- SAS (shoes)
What causes flat foot?
Ligamentous laxity with age
What is the classic presentation of plantar fasciitis?
Pain on sole of the foot with getting out of bed in the morning
How is flat foot & plantar fasciitis treated?
Arch support
Spenco
What do atherosclerosis and chronic venous insufficiency lead to?
Ischemia (involving the foot and ankle respectively)
What is the conservative management for atherosclerosis and chronic vascular insufficiency?
Diabetic shoes
How can you tell the difference between an arterial and a venous ulcer?
Arterial= necrotic (black or white)
Venous= red
How do you treat venous stasis?
Compression hose
What are the major four conditions that lead to numbness, tingling, and burning paresthesias in the elderly?
DM
B 12 deficiency
Thyroid Disease (hypo)
Alcoholism
How can you screen for neuropathy?
Monofilament (
How do you treat neuropathy?
If DM etiology, controlling blood sugar is key
- Lyrica*
