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Clinical Pharmacy 1 - Term 1 > Lecture 4 - Common Foot Disorders > Flashcards

Lecture 4 - Common Foot Disorders Flashcards

1
Q

Is the rate of mitotic division in basal cell layer normally more or less than the rate of surface cellular desquamation?

A

Normally equal

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2
Q

What occurs during corn or callus development?

A

Friction and pressure increase mitotic activity of the basal cell layer, leading to the migration of maturing cells through prickle cell and granular cell layers => hyperkeratosis

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3
Q

What are factors that contribute to corns and calluses?

A
  • Friction due to loose or tight fitting shoes
  • Structural biochemical problems
  • Not wearing socks w/ shoes or wearing ill fitting socks
  • Walking barefoot
  • Weight gain
  • Secondary condition to plantar warts
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4
Q

What is a corn?

A
  • Small raised, sharply demarcated, hyperkeratotic lesion

- Hard corns have central core that is triangular shaped and points inward

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5
Q

What are the 3 types of corns?

A
  • Soft (heloma molle)
  • Hard (heloma durum)
  • Plantar
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6
Q

What are the signs and symptoms of a hard corn?

A
  • Well defined
  • Yellowish-gray colour
  • Few mm - 1 cm or more in diameter
  • Shiny, dry, and polished
  • Central core visible
  • Pain
  • Affects skin directly overlying bony prominence or may occur on soles of feet
  • Usually occurs on surface of 4th or 5th toes
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7
Q

What are the signs and symptoms of a soft corn?

A
  • Whitish thickenings of skin
  • Soft appearance
  • Usually found on webs btwn 4th and 5th toes
  • May be painful
  • Often confused w/ Athlete’s foot
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8
Q

What is a plantar corn?

A

Corn on the plantar surface of the foot that causes pain upon walking

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9
Q

What is a plantar corn often confused with?

A

Plantar wart

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10
Q

What is a callus?

A
  • Superficial patches of hornified epidermis

- No central core

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11
Q

What are the signs and symptoms of a callus?

A
  • Yellowish-white
  • Normal skin pattern; no central core
  • Borders not well defined
  • Few mm to several cm in diameter
  • Slightly elevated
  • Found on areas where the upper layers of skin are naturally thick (soles of feet, heel/ball of foot)
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12
Q

What is the pathophysiology of plantar warts?

A
  • HPV is transmitted via person-to-person contact, autoinoculation, or via contaminated surfaces
  • HPV enters skin through small cut or abrasion
  • HPV infects upper epidermis and causes squamous epithelial cells to proliferate
  • HPV can remain latent or cause subclinical infection
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13
Q

What is a plantar wart?

A
  • Common viral infection of skin and mucous membrane
  • Benign tumours caused by human papilloma virus
  • Incubation period btwn initial infection to warty lesion varies btwn 1-8 months
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14
Q

Are warts permanent?

A

No

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15
Q

Why are warts important to treat?

A
  • Can spread
  • Unsightly
  • Can be painful and restrict activities
  • Potential to transform into malignant lesions
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16
Q

What are the signs and symptoms of plantar warts?

A
  • Can occur on sole of foot, sole of heel, great toe, head of metatarsal bone and ball
  • Circular lesion w/ wart in center
  • 0.5-3 cm diameter
  • Surface is rough, grayish-brown and friable surrounded by skin that is thick and heaped
  • Normal pattern of skin is interrupted
  • Thrombosed capillaries appear as black dots in center of lesion or as pin point bleeding sometimes described as “seeds”
  • Usually painless unless direct pressure applied
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17
Q

What is the differential diagnosis of a hard corn?

A
  • Callus

- Plantar wart

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18
Q

What is the differential diagnosis of a soft corn?

A

Tinea pedis (athlete’s foot)

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19
Q

What is the differential diagnosis of a callus?

A
  • Corn

- Plantar wart

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20
Q

What is the differential diagnosis of a wart?

A
  • Callus
  • Corn
  • Squamous cell carcinoma
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21
Q

What is the assessment for patients w/ corns, calluses, and bunions?

A
  • When possible, inspect the patient’s feet and foot­wear
  • Note the presence of lesions, changes in skin colour, sensation, texture or temperature, swelling, pain, rashes, or obvious abnormalities in foot structure
  • Check the fit of the shoe, paying special attention to its length and the width and depth of the toe box
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22
Q

What are the goals of therapy for corns and calluses?

A
  • Remove corns and calluses
  • Avoid and prevent/minimize complications
  • Prevent recurrence
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23
Q

What is the pharmacological treatment of corns and calluses?

A
  • Salicylic acid = 1st line pharmacological treatment

- For self-treatment - plaster vehicle 12-40% or collodion-like vehicle 12-17.6%

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24
Q

Salicylic acid is a _______ agent

A

Keratolytic

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25
Q

What are the advantages to an SA collodion?

A
  • Forms film which prevents moisture loss
  • Usually easiest to apply for patient
  • Less likely to run onto other areas of skin
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26
Q

What are the advantages to an SA plaster?

A
  • Provides direct and prolonged contact w/ skin
  • May be cut to fit size of lesion
  • Disks or pads more convenient
  • Easy to apply
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27
Q

What are the disadvantages to an SA collodion?

A
  • Takes longer to resolve
  • Flammable and volatile
  • Occlusive nature allows systemic absorption of drug
  • More irritating than other formulations
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28
Q

What is a disadvantage to an SA plaster?

A

Patient may be sensitive to adhesive

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29
Q

What is the indication for an SA collodion?

A

More useful in the treatment of soft corns, rather than calluses

30
Q

What is the indication for an SA plaster?

A

Hard corns and calluses

31
Q

What is the duration of treatment for an SA collodion?

A
  • Hard corns and calluses - up to 14 days

- Soft corn - 3-6 days

32
Q

What is the duration of treatment for an SA plaster?

A

Max of 5 treatments over a 2 week period (1 treatment = max of 48 hours)

33
Q

What are the directions of use for an SA liquid/collodion?

A
  • Soak foot for 5 minutes, dry foot and apply 1-2 times/day
  • Apply 1 drop at a time until area is well covered
  • Allow drops to dry and harden
  • Do not let adjacent areas of skin come in contact w/ drug
  • Periodically soak foot in warm water and remove macerated skin
34
Q

What are the directions of use for an SA plaster/disk/pad?

A
  • Soak foot for 5 minutes, dry and apply every 48h
  • If using plaster, trim plaster to follow contours of lesion
  • Apply and cover w/ adhesive tape
  • If using disk/pads, apply appropriately sized on area and cover
  • Remove w/in 48 hrs
  • Soak in warm water and remove macerated skin
35
Q

What are some non-pharms for corns and calluses?

A
  • Eliminate cause of condition
  • Soak affected area daily throughout treatment for 10 mins in warm water and gently remove dead tissue (pummice stone on wet foot or emery board on dried foot)
  • A foam or cushioned pad w/ an opening can be used up to 1 week to relieve pressure
  • Change cushion every day
  • Keep feet clean and dry
  • Avoid moisturizers between toes
  • Check feet daily
36
Q

How can you prevent corns and calluses?

A
  • Maintain moisture balance

- Remove dead skin

37
Q

What is the monitoring parameter for corns and calluses?

A
  • Visible improvement w/in a few days
  • 10-14 days for resolution of hard corn/callus
  • 3-6 days for resolution of soft corn
38
Q

When should you refer for a corn or callus?

A
  • Allergic reaction develops
  • Skin irritation develops that wasn’t present before and/or is moderate to severe
  • Skin ulcers develop
  • Any skin irritation or stinging that is bothersome to patient
  • Infection develops
39
Q

What are the goals of therapy for plantar warts?

A
  • Alleviate or prevent pain due to wart
  • Eradicate lesions and prevent proliferation
  • Prevent recurrence
  • Prevent transmission to other people
40
Q

What is the assessment for plantar warts?

A
  • Usually rough, firm hyperkeratoses that, unlike common warts on the hands, grow inwards due to pressure from walking
  • Usually skin coloured but may often be grey or brown
  • Tend to arise on the heel or the ball of the foot where microabrasions are more likely to occur and allow inoculation
41
Q

What is the pharmacological treatment for plantar warts?

A
  • Topical SA is first line
  • 12-40% in plaster vehicle
  • 5-17% in collodion-like vehicle
  • 15% in a karaya gum-glycol plaster
42
Q

Which types of warts are self-treatable?

A

Plantar and common warts

43
Q

What are the ingredients and strengths in duoplant ointment?

A
  • SA 25%
  • Formalin 5%
  • LA 10%
44
Q

What are the ingredients and strengths in duofilm liquid?

A
  • SA 16.7%

- LA 16.7%

45
Q

What is the function of formalin?

A

Antiviral activity and anhydrotic action

46
Q

What is the function of lactic acid?

A
  • Corrosive properties

- Enhances SA activity

47
Q

What are the ingredients and strengths in compound W liquid?

A

SA 20%

48
Q

What are the ingredients and strengths in soluver plus liquid?

A

SA 27%

49
Q

What are some non-pharms for plantar warts?

A
  • Advise patients that warts are contagious
  • Avoid walking barefoot
  • Change shoes and socks daily
  • Keep feet clean and dry
  • Use waterproof tape during treatment
  • Wash hands before and after cleaning feet and caring for wart
  • Use good foot hygiene even when wart is gone
50
Q

Why is duct tape often used for treatment of warts?

A

May help w/ wart removal by causing irritation

51
Q

What are the recommendations when using duct tape for plantar wart treatment?

A

Apply to wart for 6 days then remove and soak foot

52
Q

What are the monitoring parameters for plantar warts?

A
  • Improvement w/in 1-2 weeks

- Wart removal may take 4-12 weeks (max treatment time is 12 weeks)

53
Q

When should you refer for plantar warts?

A
  • Allergic reaction develops after applying the product
  • Skin is damaged and painful, inflamed, or infected
  • If wart persists after 12 weeks of treatment
54
Q

What are the side effects of salicylic acid?

A

Redness, burning, or irritation

55
Q

Salicylic should not be used on ____

A
  • Irritated, infected, or broken skin
  • Moles
  • Birthmarks
56
Q

Is salicylic acid safe to use during pregnancy or breastfeeding?

A

Unknown

57
Q

What ages shouldn’t use salicylic acid?

A
  • Under 3 years

- Over 65 years

58
Q

What should be done if a patient has multiple plantar warts?

A

Treat w/ DME/propane products only 1 wart at a time w/ a 2 week interval before treating another wart on same digit

59
Q

What ages shouldn’t use DME/propane products?

A

Under 4 years

60
Q

What are the side effects of DME/propane products?

A
  • Aching
  • Itching
  • Burning
  • Stinging sensation
  • Can cause burns and permanent scars if used on thin skin
61
Q

Are DME/propane products safe to use during pregnancy and lactation?

A

Unknown

62
Q

What are some assessment questions for corns, calluses, bunions, and plantar warts?

A
  • Who is the patient? How old are they?
  • Where is the lesion located?
  • What does the lesion look like?
  • Does it look like a mole, birthmark, or is it unusual in appearance?
  • Is there hair growing out of the lesion?
  • How many lesions are there?
  • How long have you had the problem?
  • Have you used anything to treat the problem?
  • Did you have any side effects or problems w/ previous treatments?
  • Pregnant or breastfeeding?
63
Q

What is a bunion?

A

Deformed big toe joint - joint is angled outward and big toe is angled inward towards other toes

64
Q

What is the pathophysiology of a bunion?

A
  • Hypertrophy of bone and soft tissues around middle of big toe
  • Big toe becomes abducted and rotated, which causes prolonged pressure over 1st MTP joint
  • May lead to painful inflammation and swelling of bursa over MTP joint => bunion
65
Q

What are some factors that contribute to formation of a bunion?

A
  • Inherited foot type
  • Constant abnormal joint motion
  • Ill-fitting shoes and high heels
  • Friction from bone malformations
  • Foot injuries
  • RA
66
Q

What are signs and symptoms of a bunion?

A
  • Usually bilateral
  • Bump on outside edge of big toe
  • Thickening of skin at base of big toe
  • Restricted movement of big toe
67
Q

What is a differential diagnosis of a bunion?

A

Gouty arthritis

68
Q

When would you refer a bunion?

A

Always

69
Q

What are some non-pharms for bunions?

A
  • Remove source of irritation
  • Select properly fitting footwear
  • Modify activity
  • Moleskin, foam, or cushioned pads
  • Bunion guard (soft polymer gel w/ no adhesive)
70
Q

What are treatment options for bunions?

A
  • Ice packs and OTC pain relievers to decrease pain and swelling (acetaminophen and NSAIDs at normal oral doses)
  • Splints and orthotic devices
  • Intra-articular corticosteroid injections available by physician if severe pain
  • Surgery (last resort)

Clinical Pharmacy 1 - Term 1 (18 decks)

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