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Geriatrics Exam 1 > Lecture 6- Podiatry in the Elderly > Flashcards

Lecture 6- Podiatry in the Elderly Flashcards

1
Q

Age related changes in the feet involve what major organ systems

A
  • dermatologic
  • musculoskeletal
  • vascular
  • neurologic
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2
Q

Dermatologic foot changes

A
  • Dry skin (xerosis)
  • Dystrophic toenails- fungus and ingrown
  • Hyperkeratosis- corns, calluses
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3
Q

Xerosis

A

Dry, Flaky Skin due to decrease in epidermal filaggrin

- eccrine glands decline leading to decrease in spontaneous sweating

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4
Q

Xerosis in the elderly is highly likely to be chronic ________ infection… you should perform a KOH whenever possible.

A

Athlete’s Foot (tinea pedis)

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5
Q

Treatment for Xerosis

A
  • 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
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6
Q

Onychomycosis

A

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

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7
Q

TOE CLYPT mneumoic for thick, yellow nails

A 
T- Trauma
O- Onychomycosis
E- Eczema
C- Circulatory Problems
L- Lichen Planus
Y- Yellow nail syndrome
P- Psoriasis
T- Tumor
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8
Q

Onychocryptosis

A

In grown toenails

  • result of improper nail trimming, trauma, heredity, systemic or local disease
  • have to remove the distal corners
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9
Q

Paranychia

A

When an ingrown toenail gets infected.

- S. aureus the most common pathogen, but also gram - rods are seen

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10
Q

Hyperkeratosis

A

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
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11
Q

Treatment for Hyperkeratosis

A

Debridement
Padding
Shoe Modifications

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12
Q

Foot deformities

A

Bunion (hallux valgus)
Hammertoe
Flatfoot (pes valgoplanus)
Heel pain (plantar fasciitis)

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13
Q

Bunion

A
  • prominent medial aspect of the 1st metatarsal head- the result of a tendon imbalance around the joint in a person with a flat foot.
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14
Q

Bunion treatment

A
  • Extra depth shoes (SAS)
  • Bunion Shield
  • Toe separator
  • Surgery
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15
Q

Hammertoe

A

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

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16
Q

Hammertoe Treatments

A
  • Debridement of hyperkeratotic tissue
  • Paddings to limit pressure
  • Splints to passively plantarflex toe
  • extra-depth or custom molded shoes
17
Q

Flat foot

A
  • collapse of the medial longitudinal arch due to progressive ligamentous laxity of the joints
  • AKA PRONATION
18
Q

Symptoms of flat foot

A
  • 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
19
Q

Vascular Disease

A
  • 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
20
Q

Treatment for vascular disease

A
  • Proper shoes- extra depth, and shoe inserts to offload pressure areas
  • very tight regulation of blood sugars
  • HbA1C of less than 6.5%
21
Q

Medicare’s Therapeutic Shoe Bill for Diabetics

A
  • 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
22
Q

Chronic venous insufficiency

A
  • 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
23
Q

treatment for Chronic venous insufficiency

A
  • compression
24
Q

Numbness, tingling, burning may suggest…

A
  • diabetes
  • B12 deficiency
  • Thyroid disease
  • Alcoholism
25
Q

How do you screen for neuropathy

A

Seemes-weinstein monofilament

- should perceive 7/10 areas of stimulation- if lower than that it is suggestive of anesthetic peripheral neuropathy

26
Q

Neuropathy treatments

A
  • control blood sugars if diabetic

- Lyrica the most proven treatment for PAINFUL peripheral neuropathy

Geriatrics Exam 1 (15 decks)

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