Foot Care (Parts I and II COMBINED) Flashcards
2024 - Athlete's Foot, Calluses, Corns, Bunions, Ingrown Toenail, Warts, and Hand Warts. Plantar Warts, Heel Pain, etc.,
What’s another term for Athlete’s Foot?
Tinea Pedis (= “Contagious fungal infection of the foot”)
- Tinea = Contagious fungal infection
- Pedis = “of the foot”
- The type of tinea infection is classified by where it is located on the body, not by the causative organism
Lamisil cream or spray can be used to treat some cases of Athlete’s Foot… Lamisil’s active drug ingredient is _____.
Terbinafine
Which of the following is more susceptible to developing Athlete’s Foot (Tinea Pedis)?
a) Women
b) Teenagers
c) Adults over 40
d) Children under 12
b) Teenagers
More common in men AND teenagers.
Children under 12 years of age rarely develop the condition.
How is Athlete’s Foot (Tinea pedis) primarily spread from person-to-person?
a) Through respiratory droplets
b) Through contaminated food
c) Through contaminated towels, clothing, or surfaces
d) Through direct skin contact
e) All of the above
c) Through contaminated towels, clothing, or surfaces
Athlete’s foot can be spread from person to person through contaminated towels, clothing or surfaces. Tinea dermatophytes proliferate in warm and humid places such as showers, swimming pools and changing rooms. (MedSask, 2024)
Where does Athlete’s Foot (tinea pedis) commonly occur on the body?
a) Inside the toenails
b) Instep or sole of the toes and feet
c) On the soles of the feet
d) Between the toes
e) None of the above - equally likely to occur on any parts of the feet and toes/toenails
d) Between the toes
Athlete’s foot occurs most commonly between the toes and may spread to the instep or sole. The skin may be cracked or scaly with blisters, inflammation and an itching or burning sensation. It may also cover the soles of the feet and involve the toenails. This is called moccasin-type infection.
Warm, dark, poorly ventilated, moist environments between the toes promote fungal growth and may contribute to the presence of this condition
SK Minor Ailment Considerations
When it comes to Athlete’s Foot, when are pharmacists considered to be of value and can assist patients with fungal presentations?
When the fungus is at the tip.
- Pharmacists are able to recommend either OTC antifungal agents or prescribe RX topical fungal agents for cases like these.
SK Minor Ailment Considerations
When it comes to Athlete’s Foot that involves more than 3 toes or involves different colours, why do we need to refer to an authorized prescriber like an MD?
No longer pharmacists’ territory because if it is Athlete’s Foot, would require oral antifungals. OR differential diagnoses need to be ruled out.
- Pharmacists can only prescribed for topical terbinafine NOT oral.
Athlete’s Foot
What is the course of treatment for Athlete’s Foot when using: Terbinafine 1% Cream?
Massage cream to the affected area ONCE a day for 1 week and re-assess.
What is the primary classification method for different types of tinea infections?
a) By the causative organism
b) By the age of the affected person
c) By where it is located on the body
d) By the symptoms and the severity of them
e) If it’s a fungal or non-fungal infection
c) By where it is located on the body
What are some of the more common symptoms associated w/ Tinea Pedis? (6x)
- Area is inflamed, blistered, itchy or painful
- White, cracked or macerated areas between the toes
- Most common between 3rd/4th or 4th/5th toes
- May cover soles of both feet
- Scaling and flaking
- Often comorbid with tinea cruris or tinea unguium (Onychomycosis) & may require treatment
What type of rash is often seen in Athlete’s Foot?
a) Raised, red bumps
b) Pustules filled with pus
c) Cracked or scaly skin
d) Hives or welts
c) Cracked or scaly skin
Which of the following symptoms is NOT commonly associated with Athlete’s Foot?
a) Redness and warmth
b) Dry, cracked skin between the toes
c) Itching and burning sensation
d) Thickened, discolored toenails
d) Thickened, discolored toenails is NOT affiliated with Athlete’s Foot… That can be seen in toenail fungal infections.
Tinea pedis is often the cause of tinea ______ or tinea _______ from self-inoculation.
Tinea Cruris OR Tinea Corporis
- Tinea Cruris = Jock Itch
- Tinea Corporis = Ringworm
Tinea pedis is often the cause of tinea cruris or corporis from self-inoculation (touching affected feet to other areas of the body or scratching feet and not washing hands).
How is it possible for tinea pedis to spread to other parts of a person’s body?
The infection can be spread to other parts of the body, usually the groin or underarms, by autoinoculation,
- e.g., touching the infected feet then touching other parts of the body.
Risk factors for developing Athlete’s Foot include direct contact with infected persons, animals, _______, and conditions of increased _______
- FOMITES (i.e., objects or materials that are likely to carry contaminated infections)
- Increased MOISTURE
T/F: Children under 12 years of age are commonly affected by Athlete’s Foot
False!
- Men & Teenagers are more common to contract this fungal infection.
Children under the age of 12 are unlikely to get Athlete’s Foot.
Presentation of: Moccasin-Type [of Athlete’s Foot] Infection
Might start with minor irritation, dryness, itching, burning, or scaly skin on the sole and heel of the foot.
Then can progress to thickened, cracked, peeling skin. In severe cases, the toenails become infected
What term describes a moccasin-type infection of Athlete’s Foot?
a) Blistered eruption
b) Interdigital rash
c) Vesicular eruption
d) Involvement of the soles of the feet and toenails
d) Involvement of the soles of the feet and toenails
What might be the cause of the small, raised lesions on the sole of the patient’s foot?
Identify what this could be…
Plantars Wart
Wart removal products such as Compound W comes in various kinds of formulations…
Why is it that between these two product lines, we prefer the gel instead of the solution?
Less chances of hitting healthy skin cells. AND Gel doesn’t dry out as quickly as the solution!
- Even if we had the solution bottle closed between uses, the solution will dry out faster than the gel version, so gel a good choice
Which condition is a yeast infection between the toes?
a) Athlete’s Foot (Tinea Pedis)
b) Onychomycosis
c) Wart (Plantar Wart)
d) Candidiasis
d) Candidiasis
A 40-year-old man presents to the clinic with complaints of discomfort in his feet, but more so from his toenails and the surrounding areas of the toes.
His toenails have become discolored as they’ve become more yellow, and some of the toenails have gotten thicker, too. Based on these findings, what is likely the diagnosis?
Onychomycosis
A 40-year-old man presents to the clinic with complaints of discomfort in his feet. He describes itching and burning sensations between his toes and notices some cracking and peeling skin in that area. Based on these findings…
What is the most likely diagnosis for the itching and burning sensations between the patient’s toes?
a) Athlete’s Foot (Tinea Pedis)
b) Onychomycosis
c) Wart (Plantar Wart)
d) Candidiasis
a) Athlete’s Foot (Tinea Pedis)
Which of the following is NOT a common characteristic of Athlete’s Foot?
a) Cracked or peeling skin
b) Fluid-filled blisters
c) Foul odor
d) Smooth, unblemished skin
d) Smooth, unblemished skin is NOT part of Athlete’s Foot characteristics.
Fluid-filled blisters are not always happening but when it does, need to have looked after right away.
What condition is often caused by friction or pressure on the foot?
a) Athlete’s Foot (Tinea Pedis)
b) Onychomycosis
c) Corns
d) Bunions
c) Corns
Plantar Warts are often found on ____ [part of the body].
The plantar surface of the foot
Plantar Warts results in the loss of
a) circulation
b) skin rigidity
c) healthy skin cells
d) nails
b) skin rigidity (this is often because of the distruction of skin lines/ridges)
_________ in the foot context typically affects the skin folds between the toes, resulting in a moist, red rash with satellite lesions that can sometimes look similar to acne spots filled with pus.
- Infection between the toes - moist, white peeling skin.
Candidiasis (of the foot)
in this case
Gout vs. Bunions?
Gout = Buildup of uric acid crystals in the joints.
Bunion = Involve a bony deformity at the base of the big toe and forms bony bumps at the joint.
(To the tune of “Twinkle, Twinkle, Little Star”)
Calluses, corns, and bunions too,
All affect the [ BLANK ] on your shoe.
Calluses are thick, and corns are round,
Bunions bulge where toes are bound.
Calluses form from pressure and wear,
Corns are smaller, but they can flare.
Bunions grow at the joint’s wrong bend,
Remember these, they’re skin’s true friend!
Hope this helps make it stick in your mind!
All affect the SKIN on your shoe…
(To the tune of “Twinkle, Twinkle, Little Star”)
Calluses, corns, and bunions too,
All affect the skin on your shoe.
Calluses are [BLANK], and corns are [BLANK],
Bunions bulge where toes are bound.
Calluses form from pressure and wear,
Corns are smaller, but they can flare.
Bunions grow at the joint’s wrong bend,
Remember these, they’re skin’s true friend!
Hope this helps make it stick in your mind!
Calluses are THICK;
Corns are ROUND;
(To the tune of “Twinkle, Twinkle, Little Star”)
Calluses, corns, and bunions too,
All affect the skin on your shoe.
Calluses are thick, and corns are round,
Bunions [BLANK] where toes are [BLANK].
Calluses form from pressure and wear,
Corns are smaller, but they can flare.
Bunions grow at the joint’s wrong bend,
Remember these, they’re skin’s true friend!
Hope this helps make it stick in your mind!
Bunions BULGE where toes are BOUND.
(To the tune of “Twinkle, Twinkle, Little Star”)
Calluses, corns, and bunions too,
All affect the skin on your shoe.
Calluses are thick, and corns are round,
Bunions bulge where toes are bound.
[BLANK] form from pressure and wear,
Corns are smaller, but they can flare.
Bunions grow at the joint’s wrong bend,
Remember these, they’re skin’s true friend!
Hope this helps make it stick in your mind!
CALLUSES form from pressure and wear.
(To the tune of “Twinkle, Twinkle, Little Star”)
Calluses, corns, and bunions too,
All affect the skin on your shoe.
Calluses are thick, and corns are round,
Bunions bulge where toes are bound.
Calluses form from pressure and wear,
[BLANK] are smaller, but they can [BLANK].
Bunions grow at the joint’s wrong bend,
Remember these, they’re skin’s true friend!
Hope this helps make it stick in your mind!
CORNS are smaller, but they can FLARE.
(To the tune of “Twinkle, Twinkle, Little Star”)
Calluses, corns, and bunions too,
All affect the skin on your shoe.
Calluses are thick, and corns are round,
Bunions bulge where toes are bound.
Calluses form from pressure and wear,
Corns are smaller, but they can flare.
Bunions grow at the [BLANK]’s wrong [BLANK],
Remember these, they’re skin’s true friend!
Hope this helps make it stick in your mind!
Bunions grow at the JOINT’s wrong BEND.
What are three treatment options discussed for bunions?
1) Orthodics/Special Shoes/Orthodic Devices = Podiatry Care
2) Bunion Protective Pads [for cushioning]
3) Surgery
What is the problem with the supposed three treatment considerations discussed for Bunions?
- Podiatry Care and Specialty Items
- Bunion Protection Pads
- Surgery
- Podiatry Care and products are pretty expensive.
- Bunion Protection Pads are a waste of money as it doesn’t really treat it but only has a cushion and don’t really need it.
- Surgery is a last-resort and not applicable for all people.
Define
Calluses
Localized area of thickened skin.
- We need calluses for protective purposes as the skin tries to protect itself against friction or pressure.
List the 4 Different Treatment Options Discussed for Treating Calluses.
Change footwear
Pumice Stone/File/Sanding area down.
OTC Callus Removers
— (cushion + pliable disks 40% s.a.)
— (cushion + liquid s.a.)
Protective Materials/Products (e.g., Ball of Foot Cushions)
How to treat or care for Hyperkeratotic calluses?
- MUST Sand it down (can use 100 grit sandpaper)
- Clean it out
- Use liquid or spray Band-Aid products (or Krazy Glue) to seal it… Regular adhesive bandage will Not stay intact!
If a patient came to the pharmacy asking for your recommendation on which OTC Callus Removers should they select, which of the two is considered to be a better formulation? Why?
a) cushion + pliable disks 40% s.a.
b) cushion + liquid s.a.
Cushion + Liquid salicylic acid callus removal products — this one is more likely to stay intact while wearing socks/shoes for a longer period of time… Plus liquid SA gives us better control and allowing us to place the SA where we want it to be (we don’t want it to touch healthy skin)
- The pliable disk options has the risk of sliding around S.A. on healthy skin and the disks are likely to be too small and results in undertreating… Not to mention how 40% is overkill!
Is formal counseling really ‘a thing’ for calluses? Explain.
Not really.
- Calluses are considered to be very low level so formal counselling is not usually happening unless patients has any questions.
Which of the following is a primary purpose of calluses?
a) To cause discomfort
b) To protect the skin from friction and pressure
c) To make the skin softer
d) To increase sensitivity in the affected area
b) To protect the skin from friction and pressure
Which of the following is NOT a recommended method for treating calluses?
a) Using proper footwear
b) Using over-the-counter callus removers with 40% salicylic acid
c) Using a pumice stone, cheese grater, or similar tool to file down calluses
b) Using over-the-counter callus removers with 40% salicylic acid
- This is overkill… Yet, these are what are in all the OTC products on market right now.
Corns
Hint: Something to do with a kind of localized growth
Hyper-keratotic growth – reaction to local friction/trauma/irritation over a joint
Hard Corns
- Small, raised areas of thickened skin with a hard center… usually dry and may appear yellowish or gray in color.
- Typically found on the tops or sides of toes or on the sole of the foot where pressure is applied.
- This type of corn always requires a soak before using any sort of treatment like S.A. or else can make things worse
Soft Corns
- Small, raised areas that have a softer texture in comparison to its counterpart. Appear whitish or translucent due to the moisture trapped between the toes.
- Because already macerated (softer), we do not need to soak this corn.
- Found between the toes where the skin is moist and prone to friction.
- It is necessary to COVER these corns when using SA or else will affect the adjacent toe(s)
What is the primary difference between calluses and corns?
a) Calluses are caused by fungal infections, while corns are caused by bacteria.
b) Calluses are softer and more moist than corns.
c) Calluses have a diffuse border and are larger in size, while corns have a well-defined core and are smaller.
d) Calluses are typically located between the toes, while corns are found on the palms of the hands.
c) Calluses have a diffuse border and are larger in size, while corns have a well-defined core and are smaller.
Which of the following is a characteristic feature of calluses?
a) They have a dense core of dead skin.
b) They are usually yellowish or grayish in color.
c) They commonly develop on or between the toes.
d) They are caused by pressure or friction on weight-bearing areas of the feet.
d) They are caused by pressure or friction on weight-bearing areas of the feet.
What distinguishes soft corns from hard corns?
a) Soft corns are larger in size than hard corns.
b) Soft corns have a well-defined core, while hard corns are moist and rubbery.
c) Soft corns are typically located on the palms of the hands.
d) Soft corns are moist and rubbery, while hard corns have a dense core of dead skin.
d) Soft corns are moist and rubbery, while hard corns have a dense core of dead skin.
Which corn is usually found between the two and more macerated (i.e., softens when soaked in liquid) and therefore needs to be covered when being treated to prevent it from hitting the toes next to it?
Soft corn
Which kind of corn is usually described as being harder/denser, and have less hydration in lesion?
Hard corn
What is considered to be the best form of treatment for corns?
Removing the cause
Protective materials that are available for corns include foam and moleskin:
What is our take on using Moleskin products for things like Corns?
Moleskin vs. Foam.
It might add more pressure to the area because Moleskin is thicker than foam and therefore cause more irritation because too tight to wear.
- Molefoam products is thicker and might make things tighter when wearing it on our foot as we wear shoes!
Keep in mind that any protective products we try to use needs to still be able to fit inside the shoe as we want to try to prevent irritation.
Dr. Scholls Foam Ease Corn Cushions (Foam only)…
- How does a person apply this?
- How does this product work?
Goes around the corn (surrounds the corn) and protects it from the irritation from wearing shoe so corn can slowly erode back
We prefer foam over moleskin products usually because foam is thinner and less likely to be as tight to wear with our shoes and therefore less irritation
What is the primary cause of a corn, particularly in the case of hammer toes?
a) Genetic predisposition
b) Bacterial infection
c) Local friction, trauma, or irritation over a joint
d) Allergic reaction
c) Local friction, trauma, or irritation over a joint
- Knuckle hitting up against the shoe and then causing a corn (polished skin)
What is the purpose of keratin in protecting the toe from irritation?
a) To soften the skin
b) To harden the skin
c) To prevent moisture build-up
d) To provide a cushioning effect
d) To provide a cushioning effect
We discussed about the Dr. Scholl’s® Liquid Corn/Callus Remover as only being more beneficial to one versus another:
When should we recommend this OTC product?
When should we skip this?
Recommended for CORNS
- Contains Salicylic acid 17%
We do not recommend for calluses.
Do we like these two OTC products for Ingrown Toenail(s)? Why (or why not)?
**NO!!! ** We need to get the nail tag out and none of these are going to do it…
- Outgrow contains Benzocaine: It gives people false hope as it numbs the area while the outgrown nail/skin tag remains there. Plus, NSAIDs and/or Acetaminophen does better for the pain.
- Dr. Scholl’s Toenail Softening Agent only does that (i.e., only soften the nail for easier trimming)… Hard nails are not the issue! Again, need to get the nail tag out.
Which of the following skin conditions is characterized by small, fleshy growths with black dots on the soles of the feet?
a) Soft Corns
b) Skin Tags
c) Plantar Warts
d) Flat Warts
c) Plantar Warts
What is the name of the RX agent that can be used as a wart treatment?
Canthacur
(a derivative of cantharidin)
How does Canthacur (Cantharidin) work in Wart Treatment?
Irritates the virus on the wart as much as it can and tries to kill off the entire thing.
Corns: Treatment
Salicylic Acid Preps for Corn Treatment can include the Dr. Scholl’s Corn Remover Product that contains Cushions and 40% S.A. disks…
How do I use this product?
If treating a hard corn, always be sure to soak it first….
1) Place sticky side of disc directly over center of the corn.
2) Cover the disc with a cushion (or place the cushion over top of the disc) and smooth it out.
Salicylic Acid Preps for Corn Treatment can include the Dr. Scholl’s Corn Remover Product that contains Cushions and 40% S.A. disks…
How often should people use this when treating a corn?
Once daily or EOD.
Treatment Period: ~10 days
This is a hand wart. The bump has flattened but still as a hardened white core on the plane of the skin [as pictured].
Is it okay to stop therapy? Explain.
NO! Not yet!
Despite it being flat and on the plane of the skin, it is important to continue treatment because the HPV [virus] is still intact at the root underneath the surface!
- With Canthacur (Cantharidin), you will know destruction of wart is complete as the site has healed, smooth textured skin and see normal skin lines again.
Picture is of a foot but same idea!!
When using cryotherapy/freezing therapy, application times can vary based on the location of the affected area.
If I were to be treating the arch or the toes, how should I be applying the freezing agent?
Depending on the size of the wart, freezing/contact time can vary from 10-20 seconds.
What are 2 possible causes of Ingrown Toenail(s)?
- Wearing shoes that are too tight/crowd the toenails
- Cutting the toenails too short and/or not cutting them straight across.
What is the characteristic appearance of hand warts?
a) Soft, whitish lesions with pinpoint bleeding
b) Small, rough growths with tiny black dots
c) Smooth, dome-shaped papules with a central umbilication
d) Pedunculated or sessile growths with a smooth surface
b) Small, rough growths with tiny black dots (sometimes)
Diagnosis: Case Study
A 64-year-old man complains of a painful, hardened lesion on the top of his toe. He reports discomfort while wearing shoes.
Symptoms: Painful, hardened area of skin; may have a central core.
Signs: Thickened, yellowish skin; often with a central core of keratin.
Presentation: Well-defined, round or oval-shaped lesion, usually on weight-bearing areas of the feet, such as the tops of toes or soles.
Hard Corns
- Located on the tops of the toes as well as the weight-bearing areas of the feet and experiences pain/discomfort
- Hardened area of skin with a Central core of keratin – distinguishing feature between this and calluses plus the oval-shape
Diagnosis: Case Studies
A 10-year-old child complains of a painful growth on the bottom of their foot. Upon examination, a small, cauliflower-like lesion is noted.
Symptoms: Pain or tenderness with pressure; small, fleshy growths with black dots (thrombosed capillaries) on the soles of the feet.
Signs: Small, rough growths with tiny black dots; may have a cauliflower-like appearance.
Presentation: Solitary or clustered lesions on weight-bearing areas of the feet, often with pinpoint bleeding when pared down.
What is the likely diagnosis for this 10-year-old child?
** Plantar Wart **
- The fleshy black dots are little blood vessels that have grown up into the wart. This is a distinguishing feature of plantar’s warts along with their califlower-like appearance.
- Pain and its location is also a good pinpoint of this diagnosis
Diagnosis: Case Studies
A 37-year-old woman presents with small, soft growths on her neck and underarms. She reports no pain but finds them cosmetically bothersome.
Symptoms: Soft, flesh-colored growths hanging from the skin; typically painless.
Signs: Pedunculated or sessile growths with a smooth surface; may be wrinkled or folded.
Presentation: Small, soft protrusions of skin, often in areas of friction or folds, such as the neck, underarms, or groin.
What is the likely diagnosis?
**Skin Tags **
- Symptoms, including the painless and more cosmetically bothersome effects
Diagnosis: Case Study
A 19-year-old woman presents with pain and redness along the edge of her toenail. She reports difficulty wearing shoes and notices pus drainage.
Symptoms: Pain, redness, and swelling along the edge of the toenail; may have pus drainage or infection.
Signs: Nail tag is digging into the surrounding skin; may be swollen, tender, and infected.
Presentation: Nail growing into the skin along the edge of the toenail, often causing pain, inflammation, and infection
Ingrown Toenail(s)
A 55-year-old man presents with sudden onset severe pain and swelling in his big toe joint. He reports a history of high purine diet and occasional alcohol consumption.
Symptoms: Sudden onset severe pain, swelling, redness, and warmth in one or more joints, often in the big toe joint.
Signs: Swollen, tender joint with overlying redness and warmth; may have limited range of motion.
Presentation: Acute attacks of inflammatory arthritis, commonly affecting the big toe joint (podagra), but can also affect other joints such as the ankles, knees, and wrists.
**What is the likely diagnosis? **
Gout
Diagnosis: Case Studies
A 59-year-old female presents with a toe that is bent downward at the middle joint. She reports discomfort while wearing shoes.
Symptoms: Toe bent downward at the middle joint; may cause pain or discomfort.
Signs: Deformity of the toe, usually with the proximal interphalangeal joint flexed downward and the distal joint extended.
Presentation: Abnormal positioning of the toe, often resembling a _____, with the tip of the toe pointing downward.
What is the likely diagnosis?
Hammer Toe
- A toe that is bent downward at the middle of the joint and has discomfort when wearing shoes
- Toe deformity and the pain and discomfort
Diagnosis: Case Studies
A 46-year-old male notices a painful, swollen bump on the side of his big toe. He reports difficulty fitting into shoes. He indicates his father also suffered from the same thing.
Symptoms: Painful, swollen bump on the side of the big toe; may cause redness or inflammation.
Signs: Enlargement of the first metatarsophalangeal joint; deviation of the big toe toward the other toes.
Presentation: Bony bump on the side of the foot, usually at the base of the big toe, accompanied by misalignment of the toe.
**Bunions **
- Genetic predisposition
- Misalignment of the toe - the big toe will lean on the smaller toes.
- Usually affects the big toe and will cause them to lean towards the other toes around them.
Diagnosis: Case Studies
A 6-year-old child presents with multiple small, raised lesions on their knees and elbows. The lesions are painless but concerning to the parents.
Symptoms: Small, raised bumps on the skin; usually painless. They are are smaller than other warts and, unlike other warts, these bumps are smooth on top.
Signs: Flesh-colored or slightly lighter or darker papules with a smooth surface.
Presentation: Multiple, small papules on areas of friction or trauma that can affect any area of the body such as the face, legs, elbows, or hands. Usually common among children and young adults.
**Juvenile Warts **
- Painless, smaller bumps than other warts.
- Typically found in children and young adults and in areas of the skin where there’s friction or trauma usually.
- Can be flesh-colored, or lighter or darker than the skin that surrounds them
Plantar Fasciitis
Over-stretching of the plantar fascia where can either get Inflammation, irritation and/or become swollen, which is the tissue in the foot used during walking and foot movement…
- Not associated with trauma
- As we age, we have less fat on the heel
- Can be extremely painful
Strassburg Socks
- What are their indications?
- How does it work? When to use?
- Is it effective?
- Indication: Plantar Fasciitis
- Keeps the feet and heels stretched out instead of curving inward or flopping overnight (looks like as though we are stepping on the gas pedal) and tries to keep the tendons stretched out… This prevents the tendons from shrinking and hope to prevent them from re-ripping.
- Yes, it is effective. But very expensive.
