PBL's Flashcards
VENOUS LEG UCLER
Outline the management strategy appropriate for this condition?
- Pt social and medical history
- Assessment of the wound to determine the location, size and number of the wounds.
- Assessment of the arterial supply to leg- ABI
- An ABI of <0.8 requires further investigation with duplex scan to confirm the presence and degree of arterial occlusion
- Clean wound and dress with non woven island dressing + bandage
- Advise pt to check leg for lesions, blisters
- Apply topical antibiotic
- Refer back to GP
- Track wound size
- Leg elevation
- Choose dressings that maintain adequate moisture balance, apply graduated compression bandage after evaluation of the arterial circulation and. Address patients concerns.
What does the appearance of the other leg (shown above) tell you about his past medical history?
- Venous staining- previous venous insuffiency- pooly of blood
Pagets Disease
What is Pagets Disease and who does it affect ?
• Characterised by inc bone remodelling, bone hypertrophy and abnormal bone structure that leads to pain and bone deformity and weakening
• Affects elderly
2. What is its natural history (ie how does it progress), what is the prognosis
• 5 year survival rate
• No current cure, but treatment can help relieve e.g. diphosphonates
3. Can it cause foot problems, and if so, what are the signs and symptoms that the clinician should be looking for?
• Fractures due to brittle
• Deformity of bone
• Compression on nerves from enlarged bones- leading to a loss of sensation or movement
4. What can you, as a podiatrist, do for this ?
• Foot mobilisation to restore normal function to joints to reduce pain
Charcot Marie Tooth Disease
• Neuromuscular disorder
• Hereditary motor and sensory neuropathy (HMSN), encompasses a clinically and genetically heterogeneous group of disorders characterized by muscle wasting, weakness, and sensory loss usually most severe distally.
- What are the potential problems that CMT can cause - from a podiatric perspective
• Individuals present with a cavus foot of varying degrees
• Foot drop
• On WB there is minimal change in arch heigh or length
• Sprained ankles, hammertoes, painful callus and corns
• Inversion sprains, shin splints
• Ulcers typically neuropathic in plantar and digital high pressure locations- dependant on deformity and progression of weakness and muscle imbalances
• Neuropathic pain- reduced monofilament sensation
• Gait issues
- What can you – as a podiatrist – do about this patient’s foot presentation?
• Orthoses
• Foot taping/ strapping
• Supportive footwear- high top shoes can give support for weak ankles
• GP
• Richie braces- offload plantarly
- What other potential problems can arise from development of CMT and what are the potential impacts of this condition on the patient’s lifestyles
• Impair mobility- exercising, struggle with daily living
• Nerved degeneration- loss of sensation
• Muscle weakness/ wasting
• Chronic fatigue
• Trouble breathing/ swallowing
• Scoliosis
- What is the prognosis for someone with CMT?
• Not a fatal disease and does not affect normal life expectancy
• Slow progression, varies
What are the signs and symptoms that you (as a podiatry practitioner) would expect to have presented in a patient with likely DVT?
• Throbbing or cramping pain in 1 leg (rarely in both legs) usually in calf or thigh
• Measure largest size of calf- 2 and 3cm difference
• Swelling in one leg
• Pain that may worsen
• Warm skin around painful area
• Red or darkened skin around painful area
• Swollen veins that are hard or sore to touch
• Lower extremity DVT can be symptomatic or asymptomatic.
• Pain at rest- painful to walk
Subjective:
- Bed rest, long plane flights
- Chronic venous insuffiency
- Varicose veins- becomes stagnent
What would you do to assist in your diagnosis – from simple to complex (DVT)
• Most common test is venous duplex ultrasound
• Well’s score questionnaire – will suggest if further imaging is needed
• Contrast venography
• Positive homo sign
• The biggest complication of DVT is a pulmonary embolism. Symptoms of a pulmonary embolism include difficulty with breathing/shortness of breath, chest pain, syncope and a change in mental status. One can diagnose a pulmonary embolism via a ventilation perfusion scan or a spiral CT.
• DVT in the lower limb can be classified as a) proximal, when the popliteal vein or thigh veins are involved or b) distal, when the calf veins are involved.
• findings from clinical examination are combined with the assessment of DVT medical history (such as trauma, surgery, immobilization, long-distance travel, cancer, hormone treatment, and pregnancy
What are the management strategies employed for DVT? - both short term and longer term?
Treated with anticoagulants- Monotherapy with rivaroxaban or apixaban
• don’t break up existing blood clots, but prevent clots from getting bigger and reduce risk of developing more clots.
• Long term: compression stockings-graduated compression to reduce leg swelling
o Continue medication
o Keep follow up appoints with doctor
pustular tinea
- Dry between toes properly, clean toes, when did it start, feet stay dry, type of footwear, is it painful, what type of pain is it
- Has it got better/worse?
- How often do you change your socks, how often do you clean your feet
- Family history of it? Is it anywhere else?
4 What would your management plan be? (tinea)
- Antifungal cream, keep feet clean and dry in and after the shower, possible cover and dress to stop infection, clean all socks appropriately
- Psoriasis cream, tell GP!!! (if systemic), diet, manage stress levels
Navicular Fractures and their Management
contributory factors in fractures of the navicular?
- High impact sports, trauma to the bone resulting in avascular necrosis
- Central 1/3 of navicular avascular
- Chronic trauma from repetitive foot strike
- Most common in track and field athletes
navicular #
How are they normally treated?
- Radiography, X-ray, triple phase bone scan, CT, MRI
- May be type I, II or III
- Non-weight bearing short leg cast for 6-8 weeks/high leg boot
- Check navicular tenderness on cast removal
• If still tender re-cast for 2 weeks
• If not functional rehabilitation for 6 weeks, full activity resumes 6 weeks after cast removal - Surgery indications
• Displaced or fragmented fracture
• Failed conservative therapy or delayed union/non-union
• Type III fracture
• High level athlete for faster return to play
Types of Psoriasis
• Plaque psoriasis – also known as vulgaris (most common)
• Guttate psoriasis – small red dots
• Inverse – where skin touches, localised in flexural areas of skin (armpit, groin, etc.)
• Postural (palmoplantar) – sterile vesicles on skin, may be localised to certain areas of body
One has retinopathy
One has glaucoma
One has macular degeneration
- Retinopathy retinal blood vessels leak fluid or bleed, causing macular oedema (swelling of the macular), common in diabetes – can damage central vision
- Glaucoma the nerve connecting the eye to the brain is damaged, usually due to high eye pressure (angle-closure glaucoma), eye-pain, slow vision loss, nausea
- Macular degeneration causes loss of central field of vision, center of the retina degenerates (dry), leaky blood vessels grow under the retina (wet)
Psoriasis:
• Chronic skin disease marked by periodic flare ups or sharply defined red patches covered in silver flaky skin
• Episodes and remission
• Skin lesions on trunk, limbs, elbows, knees, scalp, skin folds, sacral region and nails
• Lesion may be pustular, scaling, red, raised, demarcated, cracked and itchy
• Aetiology unknown
psoriasis patho
• Autoimmune (T cells mistake body proteins as foreign antigens)
• Overactivity of helper T cells, eventually release excess prostaglandin’s (dilating blood vessels)
• Impaired ability to regulate skin cell division
Initiating and aggravating factors
• Stress, trauma, infection, weather, drugs
psoriasis rx
• Topical – emollients, coal tar, dithranol, steroids
• Systemic – PUVA, retinoids (Vitamin A – antiaging cream), methotrexate (chemotherapy drug)
Forms of Cutaneous Malignant Neoplasm
- Melanoma
- Basal cell carcinoma
- Squamous cell carcinoma
Longitudinal Grooves
Causes:
1. Psoriasis
2. Poor Circulation
3. Frost Bite
4. Radiation
5. RA
