Lecture 6- Podiatry in the Elderly Flashcards
Age related changes in the feet involve what major organ systems
- dermatologic
- musculoskeletal
- vascular
- neurologic
Dermatologic foot changes
- Dry skin (xerosis)
- Dystrophic toenails- fungus and ingrown
- Hyperkeratosis- corns, calluses
Xerosis
Dry, Flaky Skin due to decrease in epidermal filaggrin
- eccrine glands decline leading to decrease in spontaneous sweating
Xerosis in the elderly is highly likely to be chronic ________ infection… you should perform a KOH whenever possible.
Athlete’s Foot (tinea pedis)
Treatment for Xerosis
- Wrap skin in saran wrap, soak it, gel socks
- Bag balm, Oatmeal based lotions, amlactin etc… none are prescription meds
- If you suspect tinea pedis, use OTC lamisil cream
Onychomycosis
Toenail fungus- through the production of keratinase, and the destruction of the keratin of the nail plate, allowing the nail to become thick, discolored, loosened, and collect subungual debris
TOE CLYPT mneumoic for thick, yellow nails
T- Trauma O- Onychomycosis E- Eczema C- Circulatory Problems L- Lichen Planus Y- Yellow nail syndrome P- Psoriasis T- Tumor
Onychocryptosis
In grown toenails
- result of improper nail trimming, trauma, heredity, systemic or local disease
- have to remove the distal corners
Paranychia
When an ingrown toenail gets infected.
- S. aureus the most common pathogen, but also gram - rods are seen
Hyperkeratosis
Thickened skin as a result of intermittent pressure over prominent bones
- can hide deeper skin ulcerations which will get worse if pressure continues
- A CORN
Treatment for Hyperkeratosis
Debridement
Padding
Shoe Modifications
Foot deformities
Bunion (hallux valgus)
Hammertoe
Flatfoot (pes valgoplanus)
Heel pain (plantar fasciitis)
Bunion
- prominent medial aspect of the 1st metatarsal head- the result of a tendon imbalance around the joint in a person with a flat foot.
Bunion treatment
- Extra depth shoes (SAS)
- Bunion Shield
- Toe separator
- Surgery
Hammertoe
Buckling of the toe at the PIPJ and/or DIPJ of the lesser toes due to a tendon imbalance- causes one bone to dorsiflex and one or more distal to it to plantarflex
- common in flat and high arched feet
Hammertoe Treatments
- Debridement of hyperkeratotic tissue
- Paddings to limit pressure
- Splints to passively plantarflex toe
- extra-depth or custom molded shoes
Flat foot
- collapse of the medial longitudinal arch due to progressive ligamentous laxity of the joints
- AKA PRONATION
Symptoms of flat foot
- Leg and low back pain
- Capsulitis of MPJ’s
- DJD- wear and tear arthritis of foot and ankle joints
- Tendonitis, esp. of the tibialis posterior
- Inflammation of the plantar fascia- plantar fasciitis
Vascular Disease
- Normal aging process will cause deterioration of the strucutre of arteries and veins
- can lead to atherosclerosis in arteries and malfunctioning of valves in veins (chronic venous insufficiency)
- can lead to tissue ischemia- leads to pain, ulcerations, and gangrene
Treatment for vascular disease
- Proper shoes- extra depth, and shoe inserts to offload pressure areas
- very tight regulation of blood sugars
- HbA1C of less than 6.5%
Medicare’s Therapeutic Shoe Bill for Diabetics
- 1 pair of extra depth or custom shoes as 3 pairs of protective inserts per calendar year
- letter of need has to be submitted by the primary care provider- NOT ANY OTHER SPECIALIST
Chronic venous insufficiency
- Damage to vein valves preventing efficient pumping of blood back to the heart- leads to congestion of blood in veins- causes hypoxia
- leads to edema, hemosiderin, and ulcerations
- can predispose to deep venous thrombosis and pulmonary embolism
treatment for Chronic venous insufficiency
- compression
Numbness, tingling, burning may suggest…
- diabetes
- B12 deficiency
- Thyroid disease
- Alcoholism
How do you screen for neuropathy
Seemes-weinstein monofilament
- should perceive 7/10 areas of stimulation- if lower than that it is suggestive of anesthetic peripheral neuropathy
Neuropathy treatments
- control blood sugars if diabetic
- Lyrica the most proven treatment for PAINFUL peripheral neuropathy
