start Flashcards
onychotilmania
compulsive nail biting
leukonychia
white nails
haematoma
bruise on nail
melanonychia
cancer on nail
onychomycosis
fungal nail
beau’s lines
transverse nail grooves
onychophosis
callus in sulcus
onychatrophia
mature nail regressing partially or completely
pterygium
matrix disorder where eponychium is attached to the nail bed
pnychocryptosis
IGTN
hippocratic
club nails
koilonychia
spoon shaped nails: iron deficiency
AAFFD stands for?
adult acquired flat foot deformity
PRN
review as necessary
kohlers?
avascular necrosis of navicular
what would a patient complain of if they had a morton’s neuroma?
burning, radiating foot pain
freiburg infaction
avascular necrosis of the condyle (2nd met head), which occurs from repetitive stress with microfracture . sometimes loose bodies are seen in radographs
MODA
mature onset of diabetes of the young
What is HK, what is its aetiology and predisposing factors?
Hypertrophy of corneum,
Aetiology: compression, tensile, friction, shearing,
Predisposing factors: biomechanical abnormalities, hard walking surfaces, poor footwear, fat pad atrophy
rubor
redness
calor
heat
turgor
swelling
dolor
pain
How do verrucae form, what is the classification and rx.
benign growth caused by papillomaviruses of the HPV group
Vulgaris, arida, humida, mosaic
Rx. : nothing, salicylic acid
Psoriasis:
Periodic flare ups, AI, high cell turnover,
Types: plaque, guttate, inverse, pustular,
Rx. coal tar, UV, methotrexate
What is reiter’s?
Congunctivitis
Urethritis
Arthritis
What are the risk factors for plantar melanomas?
High total naevi body count
Pre-existing naevi on soles
Hx penetrating injury
Exposure to agricultural chemicals
What the ABCDE of malignancy assessment?
Asymmetry Border irregularity Colour Diameter Elevation
Plantarfasciitis
Insidious onset First step pain Inflammation of PF Seen in combination with tight gastrocs Rx. RICE, stretching, orthotics, taping, decrease irritation, extracorporeal shockwave therapy, surgery
Differentiate between type 1 and type 2 diabetes:
AI, beta cells in the pancreas are destroyed by T cells. Reduced insulin secretion. Treat with insulin
Lifestyle related, polyuria. Polydipsia, lack of energy blurred vision weight gain, frequent infections, ulcers/slow healing, itching, skin infections, headaches, leg cramp
what do results mean in diabetes?
What are good results in diabetes? Random BG: 4-11 mmol/l FMG: > 7 mmol/l is bad 2 hour post prandial > 11 mmol is bad HbA1c>6.5% is bad
what fractures can occur on the 5th ray
- avulsion
- jones
- stress
- iselin disease/iselin’s apophysitis (avulsion in growth plate age)
dx. criteria for RA
Morning stiffness 3 or more joints Hands first Symmetrical Rhematoid nodules Serum rhematoid Radiographic changes
what changes would we see in a foot with RA?
Joint stiffness and pain Downward displacement and splaying of the forefoot Cock up toes Lateral shift of toes Contracture of extensor tendons Nodules appearing Callosity and bursa development HAV Nerve entrapment Round foot of rheumatism
clinical features of gout
First attack involves 1st metatarsophalangeal joint
Excruciating pain in big toe
Sudden onset. Instantly debilitating
Untreated attack lasts for 7 days
Further joints become involved e.g. elbows, hands
Tophi may develop
What is the funciton of the plantarfascia?
Assist in propulsion and resupination
Stiffens with increasing load
Stores elastic energy to act as a shock absorber
-resupination of the foot propulsion
What connective tissue conditions that plantarfasciitis is associated with?
RA
Ankylosing spondylitis (an inflammatory arthritis that mostly affects the spine
Psoriatic arthritis
Hyperthermia
what is ddx. Of plantarfasciitis
Joggers heel, policeman’s heel, calcaneal bursitis, fat pad rupture, stone bruise, calcaneal stress #, neuroma, severs disease, tumor, calcaneal enthesopathy
What is calcaneal enthesopathy?
Pain at insertion of achilles tendon (found on google)
compression/friction due to dysfunction of the calcaneal fat pad causing thickening of the enthesis. Can be inflammatory, degenerative, endocrine, metabolic, traumatic. considered problematic if more than 4 mm thick on sonogram
How would you manage calcaneal enthesopathy?
Activity modification, footwear changes, stretching of PF and triceps surae, cryotherapy (cold), myofascial trigger points/deep tissue massage, mobilisation, dry needling, taping
How does a low-dye taping unload the pfascia
Inverts the RF
Everts th FF
Plantarflexes the 1st ray
Supports the arch
What question would you ask for each letter in NOLDCAT?
Nature: pain, pressure, burning itching, stabbing, throbbing, aching
Onset: when do they occur i.e. when does it become painful? All the time? When walking? When resting?
Location
Duration of sx- how loing has it been there? Weeks, ? months? Recurring?
Cause Do they have any idea on what, why and where it started?
Amelioration : is there anything that makes the problem get better? Or makes it worse?
T: what previous rx have you had?
what does the ABI assess?
The ratio between the brachial BP and the ankle BP. not reliable in diabetes due to calcification of vessels
what is the best topical antifungal?
terbinafine
what rx do you use for dry skin on feet e.g. heel fissures
urea: breaks down keratin, allowing moisture to penetrate 2.5%.
what do you call the blue stuff you wrap the instruments in for sterilising?
kim guard
what is onychomadesis?
regression from proximal not distal end
what are some questions you could ask someone with diabetes?
- what type of diabetes
- duration of diabetes
- blood glucose control mechanism
- what last blood glucose reading was incl. HbA1c
- what other health professionals they see
- level of knowledge about foot care and diabetes
where is the DP pulse?
between the tendons of EHL and EDL over the top of the navicular
what sight/smell would pseudamonas make?
green, foul
what sight/smell would s. epidermidis make?
white, fruity
list (in order of 1st line 2nd line etc.) the drugs used to treat T2DM also pls give an e.g. of each
- biguanides: e.g. metformin
- sulphonylureas e.g. glicazide
- thiazolidenediones/glitazones: e.g. rosiglitazone
- alpha glucoside inhibitors: e.g. arcabose
- DPP4 inhibitors: e.g. sitagliptin
- incretin mimetics: e.g. exenatide
- SGLT2 inhibitors: e.g. canagliflozin
list sx. of DVT
- difference in colour and skin temp
- will be read and warm
- painful lef esp. in calf
- swelling and inflammation of area –> looks almost like an infection
- pain when DF foot maybe
- any long travel in general e.g. flight/bus/car
- pitting oedema at AJ due to leaky vessels
- unilateral
how do we dx. a suspected DVT?
- D-dimer blood test
- ultrasound (will only show up 3-7 days after event)
advice to pt. with suspected DVT?
- go to GP or emergency ASAP for further diagnostic testing and assessment
what is the typical management of a pt. with DVT?
anticoag approx. 12 months
heparin/warfaring
these drugs reduce clotting time (i.e. are blood thinners) so consider that!
compression stocking for flights as prevention
risk factors of Osteoporosis
- female
- post menopause
- kyphosis is commonly seen as it is caused by spinal fractures leading to compression
- smoking/alcohol
- meds: corticosteroids, thyroid hormone replacement, SSRIs, thiazolidenediones (DM), certain anti-epileptics,
- low activity levels/immobility
- fam hx. of hip #
what drugs are used for osteoporosis?
bisphosphonates e.g. zolendronic acid
what footwear considerations would you have for a patient with osteoporosis?
- stability to decrease falls risk
- extra padding because fragile bones + fat pad atrophy increase risk of stress fracture
- as light weight as possible
- orthotics probs not appropriate esp. in uncomplicated situation and no real need
what are some sx. of osteoporosis?
- # s, height loss, weight loss, LBP (lower back pain}), lower BMD
- stress # very common and easily missed
how do dx. stress fracture?
ultrasound is best. x-ray probs won’t show it if its fresssh
what is charcot marie tooth?
- genetic NM disorder causing nerve damage
- demyelinating
- progressive
- heterogenous
- more common in males
what will we see with a charcot marie tooth? CMT
- high arch/supinated foor type
- hammer toes
- drop foot
- mm wasting
- progressive
-reduced proprioception sensation
affects gait massively
pressure lesions and then ulcers common - increase risk of inversion sprains
what would you do for a pt. with CMT charcot marie tooth?
- wound care
- paddings and offloading of wounds
- orthoses need to be accomodative as opposed to corrective
- refer to surgeon if needed
- OT, physio, falls clinic
what other issues can CMT cause?
- issues with breathing
- doesnt really shorten lifespan but can be disabling and make life a bit tricky
what are risk factors of plantarfasciitis?
- BMI 25 +
- AJ DF <10 deg
WB occupation
diabetes
what ligament is most likely to be affected in an inversion ankle sprain?
ant talo fib
what is a “drawer test”
when you wiggle the metatarsal and toe to see if there is excessive ROM. if there is heaps of ROM that suggests plantar plate tear
what is the difference between onychocryptosis and paronychia?
onychocryptosis is the term given for when the nail grows inwards.
paronychia is the term for if that area gets infected
what affects skin integrity?
- neuropathy stops sweat
- hx, of skin tears,
- dry skin/dehydration
- fragile
- steroids
- corticosteroids topically
- allergies
- vascular status
- gender
- if they are hella sweaty
what’s the name of the white tape that we keep near the sports tape?
micropore surgical tape
what are subjective informations we collect from our patients regularly
- presenting complaint
- medical hx.: other conditions, past medical/surgery, fam hx.
- medications
- social hx.
- funcitonal assessment
- exercise
- footwear, orthoses/insoles/mobility aids
8 other health professionals seen regularly
what logistical information do we collect from our patients?
name, address, DOB, contact #, email
- doctor
- emergency contact
- allergies alert
- medical alert
- other considerations: interpreter, access, cultural
