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Basic Podiatric Complaints and Initial Treatments Exam Questions and Complete Solutions Graded A+
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Basic Podiatric Complaints and Initial Treatments Exam Questions and Complete Solutions Graded A+
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Basic PodiatricComplaints and Initial
Treatments Exam
Questions and Complete
Solutions Graded A+
Denning [Date] [Course title]
,Claudication - Answer: ABI apprx 0.8-0.5, muscle pain with walking. Tx: -Daily walking to build up
collateral circulation. Pt walks until
claudication pain occurs, at which time they rest for 3 minutes then walk again. This should be done at
least 8 times a day.
Medications:
aspirin, clopidogrel (Plavix), dipyridamole (Persantine) and ticlopidine. Cilostazol (Pletal) may help
improve blood flow and reduce symptoms. statin.
Vasc consult possible angioplasty.
Arterial ulcers - Answer: Segmental pressures with toe pressure >30mmhg or >45mmhg in DM pt
required for healing. Punched out lesion generally on toe, heel, dorsum of foot, or lateral ankle. Painful,
punched out, little drainage, trophic skin changes, whitish or erythematous border. Tx: do not constrict.
enzymatic or autolytic debridement preferred to mechanical.
Varicose veins - Answer: Caused by periods of increased venous
pressure due to prolonged standing, heavy lifting, or pregnancy.
SIGNS/SYMPTOMS
-Itching from an associated eczematoid dermatitis may occur
-May be asymptomatic or associated with fatigue, aching,
discomfort, fullness, or pain
-Edema, pigmentation, and ulceration of the skin may develop
TREATMENT
-Elastic stockings
-Sx excision (usually done by vascular)
-Cramps may occur at night that are relieved by elevation.
Venous insuficiency - Answer: SIGNS/SYMPTOMS
-First sign is progressive edema of the leg and is followed by changes in the skin and subcutaneous
tissues
-Usually symptoms are itching and a dull discomfort made worse by periods of standing
-Skin is usually thin, shiny, atrophic and cyanotic, and brownish pigmentation(hemosiderin deposits),
develops
,-Eczema may be present, with superficial weeping dermatitis
-Subcutaneous tissue becomes thick and fibrous
-Recurrent ulceration may occur usually just above the medial malleolus(these are usually not as painful
as an ischemic ulcer)
-Lymphedema is associated with a brawny thickening in the subcutaneous tissue also, but it does not
respond well to elevation and varicosities are absent
-Pitting edema is a sign of chronic venous obstruction or of an acute inflammatory process
-Pt may complain of fullness, aching, tiredness in leg or have no discomfort. This occurs by standing or
walking and is relieved by rest and elevation
-Night pain is relieved by getting out of bed and walking
TREATMENT
-Bed rest with legs elevated
-Support hose
-Weeping ulcers: Wet compresses for 1 hr, 4 times a day of
solution containing boric acid, Burow's solution, or saline
-Compresses are followed by local corticosteroid such as .5% hydrocortisone cream in a water soluble
base(Topical Abx may be incorporated)
-Use wet to dry dressings for ulcers with normal saline change BID. Necrotic tissue and other debris will
be removed when the dry dressing is removed. This Ix is appropriate early in ulcer management when
there is substantial exudate and debris to remove. Later the dressing can be moistened before removal
to
avoid damage to delicate healing tissue. When an ulcer is clean or shallow a hydrocolloid dressing(Le.
Duoderm) or Unna Boot may be appropriate.
-Resolution of edema is important to ulcer management:
elevation, compressi
Lymphedema - Answer: DESCRIPTION
-Accumulation of excessive lymph fluid and swelling of
subcutaneous tissue due to obstruction, destruction, or hypoplasia of lymph vessels
-May result from infection or obliteration of lymphatic tissue by excision or radiation therapy
SIGNS/SYMPTOMS
, -Nonpitting edema is a sign of lymphatic obstruction
-Onset is explosive, with chills, high fever, toxicity, and a red hot swollen leg
-Lymphangitic streaks may be seen in the skin, and lymph nodes in the groin are usually enlarged and
tender
TREATMENT
-Swelling is Tx with elevation and compression occasionally diuretics may be helpful
Morton's neuroma - Answer: A painful benign fibrotic enlargement of one of the common digital nerves
caused by shearing forces of adjacent metatarsal heads. This process most commonly affects the 3rd
common digital nerve and less commonly the 2nd. The 3rd common digital nerve is located between
and often distal to the third and fourth metatarsal head, plantar to the intermetatarsal ligament.
SIGNS/SYMPTOMS
-more common in females, possibly due to shoe gear
-most common in the 4th-6th decade of life
-pain is described as burning, cramping, or sharp and frequently radiates to the toes. Pt may also have
pain radiating proximally and may notice numbness or tingling.
-patient may feel as though they are walking on a wrinkle in their sock
-Sullivan's Sign-toes adjacent to affected interspace splay apart on weight bearing
-pain is worse in shoes and upon dorsiflexion of MPJ's(high heels)
-lateral squeeze test(point tenderness upon palpation of the plantar aspect between the metatarsal
heads while squeezing the metatarsal heads together)
-Mulder's sign-silent palpable click
-pain relieved by removing shoe and massaging affected area
TREATMENT
-modification of shoe gear
-orthotics, strapping, padding
-corticosteroid injections
-oral anti-inflammatory agents
-cold therapy, stretching and other PT modalities
-Sx, neurectomy, EDIN
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