RTS - Foot Flashcards
What is athlete’s foot?
superficial fungal infection of the feet and toes
- caused by dermatophytes = feed on keratin
- name of the group of conditions caused by dermatophytes is called tinea
- athlete’s foot is tinea pedis
What are the two types of foot disorders?
opportunistic infection - verruca = viral - athlete's foot = fungal incorrect distribution of pressure - corns
What are symptoms of athlete’s foot?
initially can be itchy and flaky between toes
flakes or scales of skin can become wet, white and macerated = begin to peel
looks white and soggy
can be reddened and sore underneath the scales
feet can often smell
there may be cracked skin that bleeds
What are practical measures for athlete’s foot?
keep skin clean and dry especially after a shower or bath
change and wash socks regularly
avoid sharing towels and walking barefoot
avoid wearing non-breathable shoes = trainers, tight shoes - fungi thrive in moist environment
avoid scratching infected skin
powder for all socks and shoes
What is the treatment for athlete’s foot?
terbinafine imidazoles tolnaftate undeconates benzoic acid (+ salicylic acid = Whitfield's ointment)
How is terbinafine used as a treatment?
most effective at preventing reoccurrence Lamisil - brand name cream/spray/gel - for 16 and over only - apply once daily for a week solution - for 18 and over only - apply once and leave in contact for 24 hrs - wash and dry after use - single use only
can cause mild irritation and stinging/burning
How are imidazoles used as a treatment?
clotrimazole - canesten and HC canesten
miconazole - daktarin and HC daktacort
ketoconazole - daktarin gold = adults only, 1 week
use two to three daily
continue 1-2 weeks after infection has cleared
can cause mild irritation and stinging/burning
hydrocortisones (HC) should only be used for severe inflammation and itching
- use once a day for 7 days maximum
How are tolnaftate and undecanoates used as treatment?
tolnaftate - mycil = brand
- powder, cream, spray and solution
- efficacy evidence is limited
- treatment should be continued for up to 6 weeks
undecanoates - mycota = brand
- treatment should be continued for 4 weeks
How is benzoic acid used as treatment?
benzoic + salicylic acid = Whitfield’s ointment
- benzoic acid decreases the pH of the dermatophytes
- salicylic acid causes the keratin layer to shed increasing penetration of other drugs
When should athlete’s foot be referred?
secondary infection - pus, yellow crusts
toe nails are also infected
diabetics
long duration/ no remission - most should show improve after 1-2 weeks
What are verrucas?
viral infection
- human papilloma virus = HPV
infectious
What causes verrucas?
constant pressure to grow inwards instead of outwards
found in weight bearing areas
- sole of the foot
What are symptoms of verrucas?
raised lesions of hyperkeratinisation - thick, horn skin = similar to corns
small black dot - due to thrombosed (clotted) capillaries = corns do not have
painful when walking due to pressure on nerve endings
What are practical measures for verrucas?
avoid walking barefoot avoid sharing towels avoid sharing shoes and socks change and wash socks regularly avoid scratching the lesions as it can cause it to spread and multiple lesions
What are the treatment for verrucas?
salicylic acid - primary treatment lactic acid gluteraldehyde silver nitrate cryotherapy
How does salicylic acid work as a treatment?
before use = once a week
- area should be soaked in warm water for 5 - 10 minutes
- area should be throughly dried
- rub the surface with a pumice stone/emery board to remove hard skin
apply gel every day
- use one daily
- apply gel to affected area only
- peel of the next day
Bazuka, occulsal , verragon
How does lactic acid work as treatment?
combined with salicylic acid
- aim to enhance penetration of salicylic acid
corrosive
- use once daily
before use = once a week
- area should be soaked in warm water for 5 - 10 minutes
- area should be throughly dried
- rub the surface with a pumice stone/emery board to remove hard skin
Duofilm, salactol, bazuka
How does gluteraldehyde and silver nitrate work?
gluteraldehyde - glutarol - skin sensitiser, stain skin brown before use = once a week - area should be soaked in warm water for 5 - 10 minutes - area should be throughly dried - rub the surface with a pumice stone/emery board to remove hard skin - paint - repeat twice daily for upto 3 months
silver nitrate
- caustic agent
- short treatment = once a day for 6 days = maximum 6 applications
- stains skin
AVOCA set
How does cryotherapy work?
Wartner - dimethyl ether/ propane mixture
freezes verrucas by destroying cytosol and cell structure
- single use only treatment but may be used again after 2 weeks
- not as effective as medical cryotherapy
medical = -196 degrees Celsius
otc - -57 degrees Celsius
What are counselling points for verruca treatment?
treatment should be continued for 3 months
- long period of treatment
- should not expect fast results
- can invite them back to monitor treatment
upto 50% can resolve spontaneously after 2 years
- may not require treatment
avoid naked flames when using treatment
easily spread by direct contact and shed skin
When should verrucas be referred?
diabetics circulatory issues compromised immune system due to disease or medication bleeding failed OTC
What are corns and calluses and where are they found?
localised formations of thick horny skin - hyperkeratinisation
hard corns - on tops of toes
soft corns - between toes
calluses - balls of feet, heel, lower border of big toe
What does corns and calluses look like?
hard corns
- central core of hard grey skin
- surrounded by a painful, raised, yellow ring of inflammatory skin
soft corns
- whitened appearance and remain soft due to moisture
- moisture causes maceration
calluses
- flattened, yellow-white and thickened skin
- can range from mm to cm
Where are bunions found and what is the cause?
ill fitting shoes and incorrect pressure distribution
inflamed skin begins to harden and burial fluid solidifies into gelatinous mass
found on the edge of the big toe
should be referred to podiatrist if too painful
What are treatment for corns and calluses?
padded shields/inserts around affected area
correctly fitting shoes
hydrocolloidon plaster - primary
- reduces pressure
- moisturises feet
- soften and remove corns
- can stay in place for days
epidermabrasion - primary
- soak skin for 5-10 mins
- physical removal using pumice stones or emery boards
kerolytic agents - secondary
- salicylic acid
