Disorders of the Foot

Front cover
half-title
Neale's Disorders of the Foot
Copyright page
Table of Contents
Web Contents and Evolve information
Foreword
Preface  to Eighth Edition
Preface  to First Edition
Acknowledgements
Contributors
1 Examination and diagnosis in clinical management
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	GATHERING DATA
	TAKING A COMPREHENSIVE  PODIATRIC HISTORY
	ELEMENTS OF THE HISTORY
		Introductory information
		Chief complaints – soliciting contribution
		Past medical history
		Drug/medication history
		Social history
		Family history
		Review of systems
	ATTRIBUTES OF SYMPTOMS
	PERFORMING THE PHYSICAL EXAMINATION
		Mental status
		Skin (see also Chs 2 and 3)
		Nails (see also Ch. 3)
		Swellings
		Musculoskeletal system (see also Ch. 8)
		Footwear (see also Ch. 18)
		Vascular assessment (see also Ch. 12)
		Neurological assessment (see also Ch. 6)
		Motor system
			Inspection
			Palpation and assessment of tone
			Assessment of power
			Assessment of reflexes
			Assessment of coordination
			Motor and sensory system functions
			Sensory investigations
				Light touch
				Pin prick
				Vibration
		Gait
			Static evaluation
			Dynamic evaluation
		Other soft tissues
		Biomechanical examination
		Further investigations
			Discharge
			Skin and nail
	APPLYING CRITICAL THINKING TO THE INFORMATION GATHERED
	DEVELOPMENT OF THE DIAGNOSIS
	CREATING THE RECORD
	REFERENCES
2 The skin and nails in podiatry
	CHAPTER CONTENTS
	KEYWORDS
	AFFECTATIONS OF THE SKIN
	STRUCTURE AND FUNCTION OF THE SKIN
	ACUTE INFLAMMATION
	CHRONIC WOUNDS (ULCERS)
		Assessment of chronic wounds
		Pathogenesis of chronic wounds
		Management of chronic wounds
	SCARRING
	BURNS
	ATROPHY
	CHILBLAINS AND CHILLING
	INFECTIONS AND THE SKIN
		Bacterial infections
			Systemic bacterial infections
			Common skin bacteria and resultant conditions
			Features of cutaneous infections
			Management of bacterial infection in the skin
		Viral infections
			Verrucae/warts
			Clinical features of verrucae (warts)
				Single plantar wart (verruca)
				Mosaic warts
			Management
				Topical preparations for wart treatment
				Electrosurgery
		Parasitic infestations
	VITILIGO
	DISORDERS OF SWEATING
	FISSURES
	CORNS AND CALLUS
		Pathogenesis of corns and callus
		Management of corns and callus
	BURSITIS
	THE SKIN AS AN INDICATOR OF PSYCHOLOGICAL DISTURBANCE
	THE NAIL IN HEALTH AND DISEASE
		Embryonic development and nail growth
		Blood supply and innervation
	INVOLUTION (PINCER, OMEGA NAIL)
		Aetiology
		Treatment
	ONYCHOCRYPTOSIS (INGROWING TOENAIL)
		Aetiology
		Treatment
	SUBUNGUAL EXOSTOSIS
		Pathology
		Treatment
	SUBUNGUAL HELOMA (CORN)
		Aetiology
		Treatment
	SUBUNGUAL MELANOMA
		Aetiology
		Treatment
	ONYCHAUXIS (HYPERTROPHIED NAIL)
		Aetiology
		Pathology
		Treatment
	ONYCHOGRYPHOSIS (RAM’S HORN, OSTLER’S TOE)
		Aetiology
		Pathology
		Treatment
	ONYCHOPHOSIS
		Aetiology
		Treatment
	PARONYCHIA
		Aetiology
		Pathology
		Treatment
	ONYCHIA
		Aetiology
		Pathology
		Treatment
	ONYCHOLYSIS
		Aetiology
		Pathology
		Treatment
	ONYCHOMADESIS (ONYCHOPTOSIS, APLASTIC ANONYCHIA)
		Aetiology
		Treatment
	ONYCHATROPHIA (ANONYCHIA)
	ONYCHORRHEXIS (REED NAIL)
	BEAU’S LINES
		Aetiology
		Treatment
	HIPPOCRATIC NAILS (CLUBBING)
	KOILONYCHIA (SPOON-SHAPED NAIL)
	ONYCHOMYCOSIS (TINEA UNGUIUM)
		Aetiology
		Pathology
		Treatment
	LEUCONYCHIA
	YELLOW NAIL SYNDROME
	PTERYGIUM
	REFERENCES
	FURTHER READING
3 Dermatological conditions of the foot and leg
	CHAPTER CONTENTS
	KEYWORDS
	Inflammatory skin diseases
		PSORIASIS AND RELATED DISORDERS
			Treatment
			Palmoplantar pustular psoriasis (PPP)
		REITER’S DISEASE
		PITYRIASIS RUBRA PILARIS (PRP)
		ECZEMA (DERMATITIS) AND  RELATED DISORDERS
			Atopic eczema
				Treatment
			Contact dermatitis
			Stasis and varicose eczema
			Pompholyx
			Juvenile plantar dermatosis
		LICHEN PLANUS
		ICHTHYOSIS
		KERATODERMAS
			Inherited palmoplantar  keratodermas
				Aetiology
				Clinical features
				Treatment
			Acquired keratoderma
				Keratoderma climactericum
				Acrokeratosis paraneoplastica  (Bazex’s syndrome)
				Keratoderma and hypothyroidism
	Blistering disorders
		EPIDERMOLYSIS BULLOSA: THE INHERITED MECHANOBULLOUS DISORDERS
		AUTOIMMUNE BLISTERING DISORDERS
	Tumours
		CAUSES OF SKIN TUMOURS
		EPIDERMAL TUMOURS
			Seborrhoeic keratosis
				Aetiology
				Clinical features
				Histology
				Treatment
			Bowen’s disease
				Clinical features
				Histology
				Treatment
			Basal cell carcinoma
				Clinical features
				Histology
				Treatment
			Squamous cell carcinoma
				Aetiology
				Clinical features
			Squamous cell carcinoma variant: verrucose carcinoma of the foot
				Histology
				Treatment
		CUTANEOUS METASTATIC DISEASE
			Clinical features
			Histology
			Treatment
		PIGMENTED SKIN LESIONS
			Naevus
				Classification of pigmented lesions
				Freckles
				Lentigo
			Congenital melanocytic naevus
				Clinical features
				Histology
				Treatment
			Acquired melanocytic naevus
				Clinical features
			Intradermal naevi
				Histology
				Treatment
			Speckled and lentiginous naevus
				Clinical features
				Histology
				Treatment
			Becker’s naevus
				Clinical features
				Histology
				Treatment
			Spitz naevus
				Clinical features
				Histology
				Treatment
			Dysplastic naevi
				Clinical features
				Histology
				Treatment
			Malignant melanoma of the skin
				Aetiology
				Clinical features
				Histology
				Treatment
			Epidermal naevi
				Clinical features
				Histology
				Treatment
			Dermal and subcutaneous naevi
		VASCULAR TUMOURS
			Pyogenic granuloma
				Clinical features
				Histology
				Treatment
			Glomus tumour
				Clinical features
				Histology
				Treatment
			Kaposi’s sarcoma
				Aetiology
				Clinical features
				Histology
				Treatment
		FIBROUS TUMOURS
			Acquired fibrokeratoma
				Aetiology
				Clinical features
				Histology
				Treatment
			Koenen’s tumours
			Dermatofibroma
				Aetiology
				Clinical features
				Histology
				Treatment
			Dermatofibrosarcoma protuberans
				Clinical features
				Histology
				Treatment
		ADNEXAL TUMOURS
			Eccrine poroma
				Aetiology
				Clinical features
				Histology
				Treatment
		OTHER STRUCTURES
			Leiomyoma
				Clinical features
				Histology
				Treatment
			Subungual exostosis
				Aetiology
				Clinical features
				Histology
				Treatment
			Myxoid cyst
				Aetiology
				Clinical features
				Histology
				Treatment
			Ganglia
				Clinical features
				Histology
				Treatment
			Bursae
				Clinical features
				Treatment
			Piezogenic pedal papules
				Clinical features
				Treatment
			Neurofibromatosis
				Clinical features
				Histology
				Treatment
	Fungal infections of the feet and nails
		DERMATOPHYTE INFECTION
			Epidemiology
			Clinical types
				Toe cleft infection
				Moccasin tinea pedis
		DIFFERENTIAL DIAGNOSIS OF  FOOT INFECTION
		NAIL INFECTION
			Clinical types
				Distal and lateral subungual onychomycosis (DLSO)
				Superficial white onychomycosis (SWO)
				Proximal subungual onychomycosis (PSO)
				Total dystrophic onychomycosis (TDO)
				Candidal onychomycosis (CO)
			Tinea incognito
		LABORATORY DIAGNOSIS OF DERMATOPHYTE INFECTION
		TREATMENT OF FUNGAL FOOT AND  NAIL INFECTIONS
			Systemic treatment of foot and  nail infections
				Safety
				Prophylaxis
	REFERENCES
4 Adult foot disorders
	CHAPTER CONTENTS
	KEYWORDS
	CLINICAL BIOMECHANICS
		The neutral or reference position
		The principle of compensation
		The gait or walking cycle
		Activity of the muscles and joints  of the limb in gait
	LOWER LIMB AND FOOT ANOMALIES
	FRONTAL PLANE ANOMALIES OF THE LOWER LIMB AND FOOT
		Leg-length discrepancy
			Incidence of LLD
			Causes of LLD
			Effects of LLD
			Symptoms of LLD
			Significance of the degree of LLD
			Assessment and measurement of LLD
			Management of LLD
		The inverted or varus rearfoot
			Coxa valgum, genu vara, tibia vara (bowleg)
			Rearfoot varus
				Causes of rearfoot varus
				Classifications of rearfoot varus
				Compensatory mechanisms in rearfoot varus
				Other compensatory mechanisms in rearfoot varus
				Uncompensated rearfoot varus
					Signs and symptoms of an uncompensated rearfoot varus
				Fully compensated rearfoot varus
					Signs and symptoms of fully compensated rearfoot varus
				Partially compensated rearfoot varus
					Signs and symptoms of partially compensated rearfoot varus
				Treatment of rearfoot varus
			Varus rearfoot
		The inverted or varus forefoot
			Forefoot varus
				Causes of forefoot varus
				Classifications of forefoot varus
				Compensatory mechanisms in forefoot varus
				Fully compensated forefoot varus
					Signs and symptoms of fully compensated forefoot varus
				Uncompensated forefoot varus
					Signs and symptoms of uncompensated forefoot varus
				Partially compensated forefoot varus
					Signs and symptoms of partially compensated forefoot varus
				Treatment of forefoot varus
			Forefoot supinatus
				Causes of forefoot supinatus
				Clinical recognition of forefoot supinatus
				Treatment of forefoot supinatus
		The everted or valgus rearfoot
			Coxa vara and genu valga/valgum (knock knees)
			True rearfoot valgus
			The valgus rearfoot
		The everted or valgus forefoot
			Forefoot valgus
				Causes of forefoot valgus
				Classification of forefoot valgus
				Rigid-type forefoot valgus
					Signs and symptoms of rigid forefoot valgus
				Mobile type forefoot valgus
					Signs and symptoms of mobile forefoot valgus
				Treatment of forefoot valgus
	SAGITTAL PLANE ANOMALIES OF THE LOWER LIMB AND FOOT
		Pelvic nutation
		Genu recurvatum
		Ankle equinus
			Aetiology and presentations of ankle equinus
			Classification of ankle equinus
			Treatment of ankle equinus
		Plantar flexed first metatarsal
		Hallux limitus/rigidus
			Aetiology of hallux limitus
				Intrinsic factors
				Extrinsic factors
			Pathology of hallux limitus
				Reduction in normal foot function, as the result  of first ray anomalies
				Pathophysiological effects of a reduced range of motion  at the first metatarsophalangeal joint
			Classification of hallux limitus
			Clinical picture of hallux limitus
			Gait and posture effects of structural hallux limitus
			Pain associated with hallux limitus  and hallux rigidus
			Shoe-wear marks
			Diagnosis and differential diagnoses
			Treatment of hallux limitus and hallux rigidus
				Conservative treatments
				Surgical treatment of hallux limitus and hallux rigidus
		Hallux flexus (acute hallux limitus)
			Pathology of hallux flexus
			Diagnosis of hallux flexus
			Treatment of hallux flexus
		Functional hallux limitus
		Sagittal plane blockade
		Hypermobile medial column/first ray
		Metatarsus primus elevatus
		Plantar-flexed fifth metatarsal
	ABNORMALITIES OF ARCH HEIGHT
		Pes planus
			Classification of pes planus
			Consequences of pes planus
			Treatment of pes planus
		Pes cavus
			Aetiology of pes cavus
			Treatment of pes cavus
	TRANSVERSE PLANE ANOMALIES OF THE LOWER LIMB AND FOOT
		Hallux abducto valgus
			Normal anatomy of the first ray
			Planar movements at the normal first metatarsophalangeal joint
			Incidence of hallux abducto valgus
			Aetiology of hallux abducto valgus
			Factors that predispose to the development  of hallux abducto valgus
				Intrinsic factors
				Extrinsic factors
				Variants of normal foot anatomy
					Metatarsus primus varus
					Relative length of the first metatarsal
					Decreased muscular function
					Iatrogenic or idiopathic features
			Pathology of hallux abducto valgus
				Excessive or prolonged foot pronation
				Pronation and supination in the first ray
				Change in the orientation of the skeletal and soft tissue components that make up the first ray
				The influence of the position of the sesamoid  complex (Fig 4.13)
				Dysfunction of soft tissue structures in hallux  abducto valgus
			Clinical picture in hallux abducto valgus
			Clinical examination in hallux adducto valgus
				Non-weight-bearing examination
				Standing examination
			Diagnosis of hallux abducto valgus
			Treatment of hallux abducto valgus
				Conservative and symptomatic management of nail and soft tissue pathologies
				Orthotic therapy
				Surgical correction of the forefoot deformity
	OTHER FOOT DISORDERS
		Osteochondrosis/osteochondritis
			Classification
			Aetiology
			Diagnosis
			Differential diagnosis
			Treatment
		Freiberg’s disease (Freiberg’s infraction)
			Pathology
			Clinical picture
			Diagnosis and differential diagnosis
			Treatment
		Kohler’s disease
			Pathology
			Clinical picture
			Diagnosis and differential diagnosis
			Treatment
		Osteochondritis dissicans of the talus
			Pathology
			Clinical picture
			Diagnosis and differential diagnosis
			Treatment
		Sever’s disease
			Pathology
			Clinical picture
			Diagnosis and differential diagnoses
			Treatment
		Iselin’s disease
	REARFOOT DISORDERS
		Posterior heel pain
		Superficial retrocalcaneal bursitis
			Pathology
			Clinical features
			Diagnosis and differential diagnosis
			Treatment
		Deep retrocalcaneal bursitis
			Pathology
			Clinical feature
			Diagnosis and differential diagnoses
			Treatment
		Achilles tendonitis
			Pathology
			Clinical picture
			Diagnosis and differential diagnosis
			Treatment
		Rupture and partial rupture of the  Achilles tendon
			Pathology
			Clinical picture
			Treatment
		Plantar heel pain
		Heel pain syndrome
			Pathology
			Clinical picture
			Diagnosis and differential diagnosis
			Other causes of plantar heel pain
				Subcalcaneal bursitis
				Entrapment neuropathy
				Radiculopathy of the first sacral spinal nerve  (s1 radiculopathy)
			Treatment of plantar heel pain
		Tarsal tunnel syndrome
			Pathology
			Clinical features
			Treatment
		Tibialis posterior tendon dysfunction
			Aetiology
			Pathology
			Clinical picture
			Diagnosis and differential diagnosis
			Treatment
				Conservative therapies
				Surgical procedures
		Tarsal coalition
			Pathology
			Clinical presentation
			Diagnosis and differential diagnoses
			Treatment
	MIDFOOT DISORDERS
		Plantar fibromatosis
			Pathology
			Clinical features
			Diagnosis and differential diagnosis
			Treatment
		Tarsal arthritis
			Pathology
			Clinical picture
			Diagnosis and differential diagnoses
			Treatment
		Plantar fasciitis
			Pathology
			Clinical picture
			Diagnosis and differential diagnosis
			Treatment
	FOREFOOT DISORDERS: METATARSALGIA
		Classification of metatarsalgia
		Functional metatarsalgia
			Pathology
			Clinical presentation
			Management
		Non-functional metatarsalgia
			Categorisation of non-functional metatarsalgia
			Focal hyperkeratoses
				Metatarsalgia relating to soft tissue pathologies
				Pathology
				Clinical picture
				Diagnosis
				Treatment
		Metatarsalgia due to synovial  tissue pathologies
			Ganglia/ganglionic cysts
				Pathology
				Clinical picture
				Treatment
			Capsulitis
				Pathology
				Treatment
			Gouty tophus
				Pathology
				Clinical picture
				Diagnosis
				Treatment
			Problematic bursae
				Treatment
			Rheumatoid nodules and rheumatoid bursae
				Pathology
				Clinical picture
				Treatment
			Plantar plate rupture
				Pathology
				Clinical picture
				Diagnosis and differential diagnoses
				Treatment
		Neurological problems
			Sensory problems, paraesthesia and  painful neuropathy
			Nerve entrapment/Morton’s neuroma
				Pathology
					Compression and tension of the plantar digital nerves
					Distal extension of the intermetatarsal bursa
					Transient ischaemia
					Biomechanical influences
				Clinical picture
				Diagnosis and differential diagnosis
				Treatment
		Metatarsalgia arising in association  with bone pathologies
			Stress fracture
				Pathology
				Signs that indicate a stress fracture
				Factors that predispose to stress fracture
				Diagnosis
				Treatment
			March fracture
				Clinical picture
				Diagnosis and differential diagnosis
				Treatment
			Principles of recognition and treatment of stress fractures elsewhere in the foot
			Sesamoid pathologies
				Relationship of flexor hallucis brevis sesamoids and  the first metatarsal head
				Clinical picture
				Diagnosis and differential diagnosis
				Treatment
				Sesamoid fractures
				Sesamoid osteochondritis
			Freiberg’s infraction
			Complications following metatarsal surgery
		Systemic diseases that may give rise  to metatarsalgia
			Rheumatological diseases
			Arthropathies
				Osteoarthritis
				Rheumatoid arthritis
				Ankylosing spondylitis
				Connective tissue disorders
				Infective and reactive arthritis
				Arthropathy associated with other disease states
		Other causes of metatarsalgia
			Plantar fibromatosis
			Altered tissue perfusion and reduced  vascular drainage
			Generalised muscular pathology
			Neoplastic disease
			Back pain
			Soft tissue effects of rheumatic disease
			Miscellaneous systemic causes of metatarsalgia
	REFERENCES
5 Circulatory disorders
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	ARTERIOSCLEROSIS (HARDENING OF  THE ARTERIES)
	ATHEROSCLEROSIS  (MACROVASCULAR DISEASE)
		Epidemiology
		Pathology
	RISK FACTORS
		Modifiable factors
			Smoking
			Lipid disorders
				Primary hyperlipidaemias
				Secondary hyperlipidaemias
			Diabetes mellitus
			Hypertension
			Obesity
			Homocysteine
			Haemostatic variables
			Sedentary lifestyle
			Dietary deficiencies of antioxidant vitamins and polyunsaturated fatty acids
			Type A behaviour pattern (TABP)
		Fixed factors
			Age and sex
			Family history
	CLINICAL FEATURES
		Intermittent claudication
		Rest pain
	DIAGNOSIS
	ASSESSMENT OF SKIN BLOOD FLOW
	CLINICAL MANAGEMENT
		Risk reduction
			Smoking
			Elevated cholesterol
			Glycaemic control
			Blood pressure control
			Obesity
			Antiplatelet therapy
			Elevated homocysteine
		Drug therapy
		Exercise therapy
		Alternative therapies
		Vascular intervention
	ACUTE ARTERIAL OCCLUSION
	VASCULITIS
		Thromboangiitis obliterans  (Buerger’s disease)
			Epidemiology
			Aetiology
			Clinical features
			Pathology
			Differential diagnosis
			Treatment
			Prognosis
		Polyarteritis nodosa
			Clinical features
			Differential diagnosis
			Treatment
		Rheumatoid vasculitis
	VASOSPASTIC DISORDERS
		Raynaud’s phenomenon
		Clinical features
		Pathology
		Treatment
	ACROCYANOSIS
	ERYTHOMELALGIA
	LIVEDO RETICULARIS
	ERYTHEMA ABIGNE
	FROSTBITE
	IMMERSION FOOT (TRENCH FOOT)
	MICROVASCULAR DISEASE
	VENOUS DISEASE
		Deep venous thrombosis (DVT)
			Clinical diagnosis
			Clinical features
			Treatment
	PULMONARY THROMBOEMBOLISM
	SUPERFICIAL THROMBOPHLEBITIS
	CHRONIC VENOUS STASIS
		Clinical features
		Treatment
	LYMPHATIC DISEASE
	LYMPHOEDEMA
		Primary lymphoedema (Milroy’s disease)
		Secondary lymphoedema
		Clinical features
		Diagnosis
		Treatment
	FURTHER READING
6 Neurological disorders in the lower extremity
	CHAPTER CONTENTS
	KEYWORDS
	THE SPINAL CORD PATHWAYS AND CLINICAL EXAMINATION
		Ascending pathways
		Descending pathways
	PERIPHERAL NERVE INJURY
	PERIPHERAL ENTRAPMENT NEUROPATHIES
	HEREDITARY MOTOR AND  SENSORY NEUROPATHIES
	SPINAL RADICULOPATHIES
	CHARACTERISTICS OF CEREBELLAR LESIONS
	CHARACTERISTICS OF BASAL  GANGLIA LESIONS
		Hyperkinetic dyskinesias
			Huntington’s chorea
			Sydenham’s chorea or St Vitus’ dance
		Hypokinetic dyskinesias
			Parkinsonism
	CEREBRAL PALSY
	AUTONOMIC NERVOUS SYSTEM
		Sympathetic nervous system dysfunction  in the lower extremity
	DIABETIC PERIPHERAL NEUROPATHY
	CHARCOT JOINT DISEASE
	DISORDERS OF NEUROMUSCULAR TRANSMISSION
	REFERENCES
	FURTHER READING
		Peripheral nerve injury
		Low back pain
		Hereditary motor and sensory neuropathies
		Entrapment neuropathies
		Cerebellar lesions
		Basal ganglion disease
		Cerebral palsy
		Diabetic neuropathy
		Complex regional pain syndrome
		Myasathenic syndromes
7 Podiatry in the management of leprosy  and tropical diseases
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	LEPROSY
		Epidemiology
		Classification
			Neuropathy in tuberculoid leprosy
			Neuropathy in lepromatous leprosy
			Neuropathy in borderline (dimorphous) leprosy
		The lower limb in Hansen’s disease
			Anaesthesia
			Factors associated with plantar ulceration
				Motor paralysis
				Claw toes
				Extrinsic muscle paralysis
				Pre-existing pathomechanical foot function
				Tarsal disintegration
				Absorption and pathological fractures
				Autonomic impairment
				Social and behavioural variables
			Complications of ulceration
				Secondary infection
				Squamous-cell carcinoma
			Treatment of pedal pathologies
				Ulceration
					The active phase of ulceration
					The proliferative phase of ulceration
					The maturation or remodelling phase of ulceration
				Mal perforans
				Enhancing the healing process
					Infection control
					Maintaining an optimal wound environment
					Rest
				Orthotic options
		Case studies
	TROPICAL DISEASES
		Bacterial infections
			Pyogenic infections
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
			Treponemal infections
			Other bacterial infections manifesting on the foot
			Mycobacterial infections
				Aetiology and pathogenesis
				Clinical findings and diagnosis
					Fish-tank granuloma
					Leprosy
					Skin tuberculosis
					Buruli ulcer
				Management and treatment of mycobacterial infections
			Bacterial mycetoma
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
		Parasitic diseases, ectoparasite infestations and bites
			Cutaneous larva migrans
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
			Leishmaniasis
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
			Gnathostomiasis
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
			Tungiasis
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
			Myasis
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
			Scabies
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
			Ticks
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
			Fleas
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
		Fungal conditions
			Eumycetoma
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
			Chromoblastomycosis
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
			Dermatophytes
				Aetiology and pathogenesis
				Clinical findings and diagnosis
				Management and treatment
			Systemic mycosis manifesting on the feet
				Coccidioidomycosis
				Paracoccidioidomycosis
		Viral infections
		Miscellaneous conditions
			Ainhum
			Pellagra
			Drug reactions, chronic dermatitis and other  skin conditions
			Seaborne conditions
	REFERENCES
	Further reading
8 Musculoskeletal disorders
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	DEFINING RHEUMATOLOGY AND THE MUSCULOSKELETAL DISEASES
	GENERAL EPIDEMIOLOGY OF  RHEUMATIC CONDITIONS
	BURDEN OF DISEASE
	THE EPIDEMIOLOGY OF FOOT PROBLEMS GENERALLY AND IN RHEUMATOLOGY
	A BRIEF OVERVIEW OF DEVELOPMENTS IN MEDICAL RHEUMATOLOGY
	MEDICAL MANAGEMENT IN RHEUMATOLOGY – OVERVIEW  ACROSS DISEASES
	THE FOOT IN RHEUMATOLOGY – OVERVIEW ACROSS DISEASES
		Assessing the foot
		Management principles
		Provision of foot health services –  current provision, multidisciplinary involvement, surgery
			Service provision
				Education and self-management advice
				General foot care, nail cutting, corn and callus reduction, provision of padding
				High-risk management of the vasculitic or ulcerative foot
				Extended scope practice and surgery
	SPECIFIC DISEASES
		Seropositive inflammatory arthritis
			Rheumatoid arthritis
				Definition
				Epidemiology
				Diagnosis
				Pathology
				Clinical course
				Medical management
				The foot in rheumatoid arthritis
					Hindfoot
					Midfoot
					Forefoot
					Subcutaneous lesions
					Skin and nails
					Vasculitis
			Juvenile idiopathic arthritis
				Definition
				Epidemiology
				Classification
				Diagnosis
				Pathology
				Clinical course
				Medical management
				The foot in juvenile idiopathic arthritis
					Polyarticular type
					Enthesitis-related arthritis and psoriatic arthritis
		Seronegative inflammatory arthritis:
			Introduction – common features
			Ankylosing spondylitis (inflammatory back pain)
				Definition
				Epidemiology
				Diagnosis
				Pathology
				Clinical course
				Medical management
				The foot in ankylosing spondylitis
			Psoriatic arthritis
				Definition
				Epidemiology
				Diagnosis
				Pathology
				Clinical course
				Medical management
				The foot in psoriatic arthritis
			Reactive arthritis
				Definition
				Diagnosis
				Medical management
				The foot in reactive arthritis
		Connective tissue diseases – scleroderma and lupus
			Scleroderma
				Definition
				Epidemiology
				Diagnosis
				Clinical course
				Medical management
				The foot in scleroderma
			Lupus
				Definition
				Epidemiology
				Diagnosis
				Pathology
				Clinical course
				Medical management
				The foot in lupus
		Osteoarthritis
			Definition
			Epidemiology
			Diagnosis
			Pathology
			Clinical course
			Medical management
			The foot in osteoarthritis
		Crystal arthropathies  (gout and pseudogout)
			Definition
			Epidemiology
			Diagnosis
			Pathology
			Clinical course
			The foot in crystal arthropathies
			Infective arthritis
				The foot in infective arthritis
		Other rheumatological conditions
			Fibromyalgia
				Definition
			Polymyalgia rheumatica
			Sjögren’s syndrome
			Joint hypermobility syndromes
				Definition
				Epidemiology
				Diagnosis
				Pathology
				Clinical course
				Medical management
				The foot in hypermobility syndrome
		Miscellaneous other conditions
	ASSESSING OUTCOMES IN  RHEUMATIC DISEASE
	SUMMARY
	ACKNOWLEDGEMENTS
	REFERENCES
9 Metabolic disorders
	CHAPTER CONTENTS
	KEYWORDS
	DIABETES MELLITUS
		Type 1 diabetes
		Type 2 diabetes
		Secondary diabetes
		Diagnosis
		Clinical features
		Treatment
			Treatment of type 1 diabetes mellitus
			Treatment of type 2 diabetes mellitus
		Hypoglycaemia
		Complications and control of diabetes
		Eye disease
			Background retinopathy
			Proliferative retinopathy
		Kidney disease
		Neuropathy
			Symmetrical sensory and autonomic neuropathy
			Neuropathies that recover, mononeuropathies, radiculopathies and acute painful neuropathies
			Pressure palsies
			Symptomatic autonomic neuropathy
				Symptoms
				Diagnosis
		Vascular disease
		The diabetic foot
			The neuropathic foot
				Neuropathic ulcer
					Complications of ulceration
					Management of ulceration
				Neuropathic (Charcot) joint
					Management
				Neuropathic oedema
			The neuroischaemic foot
				Pathogenesis
				Presentation
				Management
	OBESITY
	METABOLIC BONE DISEASE
		Bone and calcium metabolism
		Hormonal physiology
		Hypercalcaemia
		Hypocalcaemia
		Osteoporosis
		Osteomalacia and rickets
		Hyperparathyroidism
		Renal osteodystrophy
		Paget’s disease
	METABOLIC DISORDERS AND  PODIATRIC MANAGEMENT
	REFERENCES
	FURTHER READING
10 Management of high-risk patients
	CHAPTER CONTENTS
	KEYWORDS
	AIMS IN MANAGING HIGH-RISK PATIENTS
	PREVENTION OF COMPLICATIONS
		History taking and assessment
		General points regarding treatment
	MANAGEMENT OF ESTABLISHED WOUNDS, INFECTION OR NECROSIS
		Examination of the wound
			Infection
		Management of wounds
		Desloughing and wound cleansing agents
			Desloughing agents
			Wound-cleansing agents and antiseptics
			Antiseptics
		Dressings
			1. The ability to remove exudate
			2. The ability to maintain humidity at the  wound–dressing interface
			3. Permeability of the dressing to gases
			4. The ability to be impermeable to microorganisms
			5. The ability to maintain a suitable temperature at the wound surface
			6. The ability to maintain low adherence at the  wound–dressing interface
			7. The ability to be free from contaminants
			8. The ability to maintain a suitable pH
			9. Other factors, including patient acceptability, ease of application and comfort, and cost
			Types of dressing for use in podiatric practice
			Conventional dressings
			Primary wound-dressing films
				Semipermeable adhesive film dressings
				Perforated film absorbent dressings
			Low-adherent wound contact layers
				Unmedicated
				Medicated
			Semipermeable hydrogels
			Hydrocolloids
			Alginate dressings
			Polyurethane foams
			Silver agents
		Other dressings – the way forward?
	OTHER ASPECTS OF MANAGEMENT
	CONCLUSIONS
	REFERENCES
	FURTHER READING
11 Podiatric management of the elderly
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	NAIL CONDITIONS AND CARE
	RISK FACTORS ASSOCIATED WITH  THE DEVELOPMENT OF ULCERATION  IN THE FEET AND LEGS
		Health professionals involved in multidisciplinary care
			Dietician
			District nurse
			Vascular specialist
	MUSCULOSKELETAL CHANGES
		Muscle tissue
		Tendon and ligament
		Management of change
	FALLS IN OLDER PEOPLE
		Risk factors associated with falls
		What is the ideal footwear style for an older person?
	POLYPHARMACY
		Long-term disease and older people
	QUALITY OF LIFE
	DUTY OF CARE
		Hypothermia risk
		Dehydration
		Dementia and depression
		Osteoporosis and fracture
		Incontinence
		Malnutrition
	CONCLUSION
	ACKNOWLEDGEMENT
	REFERENCES
	FURTHER READING
12 Paediatric podiatry and genetics
	CHAPTER CONTENTS
	KEYWORDS
	NORMAL GROWTH AND DEVELOPMENT
		Knock-knee, bow leg and rickets
			Rickets
		Flat foot
		Peak rates of growth
	FOOTWEAR
		Inadequate footwear
			Plimsolls
		Babywalkers
		Fashion, peer-group pressure  and economics
		Trainers
	FOOT TYPE
		Low-arched and high-arched feet
	INFECTIONS
		Onychocryptosis (ingrowing toenail)
	ANATOMICAL ANOMALIES
		Sesamoid bones
		Supernumerary bones
		Tarsal coalition (peroneal spastic flat foot)
	BIOMECHANICAL ANOMALIES/ABNORMALITIES
		Acquired deformity
		Mucopolysaccharidosis
		Juvenile hallux abducto valgus
	INJURIES
		Juvenile hallux rigidus
	CONGENITAL ABNORMALITIES
	BASIC PRINCIPLES OF HUMAN GENETICS
	GENETIC AND CONGENITAL DISORDERS
		Chromosome abnormalities
		Single-gene disorders
		Multifactorial disorders
	SYNDROMES
		The lower limbs
			Polydactyly
			Syndactyly (webbed toes – zygodactyly)
	ASSESSMENT OF A FAMILY WITH A GENETIC DISORDER
		Drawing the family tree
		Interpreting the family tree
	OLIGODACTYLY
	CONGENITAL OVERLAPPING FIFTH TOE (DIGITI MINIMI QUINTI VARUS)
	CURLY TOES
	CONGENITAL FLEXED TOE
	METATARSUS ADDUCTUS
	HALLUX VARUS
	CONGENITAL TALIPES  EQUINOVARUS: CLUBFOOT
	TALIPES CALCANEOVALGUS
	VERTICAL TALUS (ROCKER BOTTOM FOOT)
	ONYCHOGRYPHOSIS
	ARTHROGRYPOSIS MULTIPLEX CONGENITA
	CONGENITAL CONSTRICTION  BAND SYNDROME
	POSTURAL ANOMALIES/ABNORMALITIES
	SURGICAL/MEDICAL CONDITIONS
		Leg-length discrepancy
		Linear scleroderma
			Localised scleroderma (morphea)
		Pes cavus
		Sever’s disease (calcaneal apophysitis)
		Kohler’s disease of the navicular
		Freiberg’s disease
		Stress fracture of a metatarsal (march or fatigue fracture)
		Diabetes
		Poliomyelitis
		Spina bifida cystica
		Cerebral palsy
		Muscular dystrophies
			Duchenne muscular dystrophy
		Hypermobility syndrome
		Ehlers–Danlos syndrome
		Limb pain of childhood with no  organic disease
		Juvenile idiopathic arthritis (juvenile chronic arthritis)
		Psoriatic arthritis
		Raynaud’s phenomenon
		Haemophilia
		Turner’s syndrome
		Down’s syndrome (trisomy 21)
		Tuberous sclerosis
	DERMATOLOGICAL CONDITIONS
	EXAMINATION AND ASSESSMENT
		Observe gait and posture with footwear
		Subjective questioning of child and/or parent
		Measure feet, measure footwear
		Examine footwear
		Visual examination of foot for skin, nail, soft-tissue and bony lesions
		Physical examination of lesions as required
			Physical examination of range, quality and direction of motion in all joints of the foot
		Biomechanical assessment, including examination for forefoot/rearfoot malalignment
		Observe and assess barefooted gait  and general posture
		Comparison
		Diagnosis
		Produce a management plan
		Written information
	MANAGEMENT
		Footwear advice and prescription
		Passive and active exercises
		Orthoses for passive and dynamic use
			Night splints
			Silicone
		Casted foot orthoses
	THE ROLE OF THE PAEDIATRIC PODIATRIST
	REFERENCES
	FURTHER READING
13 Sports medicine and injuries
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	ATHLETIC PROFILE AND HISTORY TAKING
		Past treatment history
	CHRONIC OR OVERUSE INJURIES
		Physical factors
		Psychological factors
		Patient constraints
	RUNNING
		The four phases of running
		The walking–running cycle
		Marathon running
	CHILD AND ADOLESCENT SPORTS
	FOOTBALL – SOCCER
	GYMNASTICS
	BASKETBALL
	BOWLING
	TENNIS
	GOLF
	AMERICAN FOOTBALL
	RUGBY
	STEP/BENCH AEROBICS
	BALLET AND DANCE
		Tendinitis
		Posterior and anterior impingement  syndrome of the ankle
		Shin splints
		Ankle sprains and toe sprains
		Stress fractures
		Hallux limitus
		Bunion deformities
		Neuromas
		Nail problems
	BASEBALL
	SKIING
		Cross-country skiing
	SNOWBOARDING
	FOREFOOT INJURIES
		Metatarsalgia
		Capsulitis
		Bursa formation and bursitis
		Sesamoiditis and fracture
		Metatarsal stress fractures
		Osteochondritis dissicans –  Freiberg’s infraction
		Morton’s neuroma
		Hallux limitus and rigidus
		Bunion deformity in the athlete
			Tailor’s bunion
	REARFOOT INJURIES
		Infracalcaneal heel pain
		Ankle equinus
		Achilles tendon injuries
			Partial rupture of the Achilles tendon
			Acute complete rupture of the Achilles tendon
			Insertional Achilles tendinitis and calcific tendinosis
		Retrocalcaneal exostosis  (Haglund’s deformity)
	ANKLE INJURIES
		Anatomy
	LEG INJURIES
		Chronic leg pain in the athlete
		Tibial fasciitis – shin splints
			Treatment
		Stress fracture of the tibia and fibula
		Acute and chronic compartment syndrome
			Anatomy
		Muscle soreness
		Muscle cramps
		Muscle herniations
		Posterior tibial tendon dysfunction  in the athlete
			Anatomy
			Aetiology
			History, physical examination and clinical findings
		Fibular (peroneal) tendinitis  and tenosynovitis
			Subluxing fibularis (peroneus) tendons
		Overuse knee injuries
			Definition
			Symptoms
			Signs
			Treatment
			Biomechanical causes of knee injuries
		The patellofemoral joint
			Patellofemoral problems in runners
			Chondromalacia patellae
		Knee plica
		Iliotibial band friction syndrome
		Popliteus tendinitis
		Hamstring tendinitis
		Groin injury/strain
	LEG-LENGTH DISCREPANCY
	THE FEMALE ATHLETE TRIAD
	SPORTS SHOES
		Shoe manufacture
			Lasts
				Shape of the last
			Other factors
				The heel counter
				The tongue
				Insole
				Outsole
				Midsole
				Upper
			Scientific evaluation
			Features of a good sports shoe
	REFERENCES
14 Basic biomechanics of gait
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	CONTACT FORCES AND  ATTRACTION FORCES
		Mass and weight
		Units of force
		Scalars and vectors
	CENTRE OF GRAVITY
	MUSCULOSKELETAL SYSTEM FUNCTION
	STABILITY
	CENTRE OF PRESSURE
	LOAD, STRAIN, AND STRESS
		Tension stress
		Compression stress
		Shear stress
	GAIT CYCLE
		Trajectory of the centre of gravity
		Ground reaction force
		Components of the ground reaction force
		Path of the centre of pressure
	GAIT ANALYSIS
		Diagnosis of gait disorders
		Qualitative gait analysis
		Quantitative gait analysis
	REFERENCES
15 Structure and function of the foot
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	SKELETON OF THE FOOT
	MOVEMENTS OF THE ANKLE AND FOOT
		Ankle joint
		Subtalar joint
		Pronation and supination
	ARCHES OF THE FEET
		Passive arch support
		Active arch support
		Interaction of the arch support mechanisms
	THE WINDLASS MECHANISM OF THE FOOT
	STRUCTURAL ADAPTATION OF THE MUSCULOSKELETAL SYSTEM
		Structural adaptation in bone
		The chondral modelling phenomenon
		Modelling of metaphyses and epiphyses
		Modelling of articular surfaces
	REFERENCES
16 Clinical therapeutics
	CHAPTER CONTENTS
	KEYWORDS
	THE THERAPEUTIC MANAGEMENT OF SUPERFICIAL LESIONS
		Operating
		Medicaments
		Dressings
		Padding and strapping
		Review periods
		Case records
	CONTROL AND TREATMENT OF THE HYPERKERATOSES
		Pathological callus
			Postoperative antisepsis
			Emollients
			Astringents
			Silicone implants
		Heloma durum (hard corn) of the digits
		Heloma durum (hard corns) on the plantar metatarsal area
		Interdigital heloma
		Vascular and neurovascular heloma
		Heloma miliare (seed corns)
		Palmoplantar hyperkeratosis
	SHORT-TERM PADDING THERAPY
		Digital padding for the lesser toes
		Plantar metatarsal padding
	THE TREATMENT OF VERRUCA PEDIS
		The treatment of verrucae
			Chemical cautery
			Disadvantages of treatment with chemical therapy
			Therapeutic agents for chemical cautery
				Salicylic acid
				Monochloroacetic acid
				Trichloroacetic acid
				Potassium hydroxide
		Single-treatment techniques
			Cryotherapy
			Electrosurgery and radiosurgery using cutting, coagulation, desiccation and fulguration
				Background
				Electrosurgical physics
				Equipment
				Safety
				Patient selection
				Procedures
				Electrosurgical treatment of verrucae
				Nail bed ablation
				Suggested procedure for desiccation of heloma durum (hard corn)
	INFLAMMATORY CONDITIONS
		Perniosis (erythema pernio, chilblains)
		Ulceration
	TREATMENT OF DISORDERS OF THE  SWEAT GLANDS
		Hyperhidrosis
		Anhidrosis
	TREATMENT OF FUNGAL INFECTIONS
		Tinea pedis
			Clinical features of tinea pedis
			Treatment
				Undecenoic acid
				Tolnaftate
				The imidazoles
				Tea tree oil
		Tinea unguium (onychomycosis)
			Clinical features of tinea unguium
		Candidosis
	PHYSICAL THERAPY
		Heat and cold
		Heat
			Physiological effects
			Increased blood supply
			Generalised effects of heating
			Heat therapy
				Infrared radiation
			Ultrasound
		Cold
			Cryotherapy/cold therapy
				Ice packs
				Cold sprays
	FOOTBATHS
		Methods of application
			Cold footbaths
			Contrast footbaths
			Warm water footbaths
			Hypertonic footbaths
			Antiseptic astringent footbaths
	LASERS
		Properties of laser light
		The effect of laser light
		Safety
		Treatment technique
			Contraindications
			Laser in patient management
	MAGNETOPULSE
		Contraindications
		Operation of magnetopulse equipment
			Method: machine with two pads
			Method: machine with four pads
			Indications
	NON-THERMAL ELECTROTHERAPY
		Faradism – muscle stimulation
		Technique
			Electrodes
		Interferential
			Relief of pain
			Motor stimulation
			Technique
			Contraindications
	ACUTE AND CHRONIC INFLAMMATORY CONDITIONS
		Tension strappings
		Medial support
		Lateral support
		Neutral support
		Valgus padding
			Applications
		Tarsal platform (filler pad)
			Applications
			Tarsal cradle
		Padding and strapping for hallux  abducto valgus
		Padding and strapping for hallux  limitus/rigidus
		Plantar digital neuritis
		Plantar fasciitis
			Method
		March fracture
		Freiberg’s infarction
	REFERENCES
	FURTHER READING
17 Orthoses
	CHAPTER CONTENTS
	KEYWORDS
	PRINCIPLES OF MANAGEMENT
	REPLACEABLE PADS
	ELASTIC ANKLETS AND BRACELETS
	INSOLES
		Non-casted insoles
		Casted insoles
	FUNCTIONAL ORTHOSES
		The Root paradigm
		The sagittal plane paradigm
		The proprioceptive, preferred- motion-pathway paradigm
		The tissue-stress paradigm
		Paradigms in practice: reconciling the controversy of foot function paradigms
		Material choice and casting techniques
		Custom versus prefabricated orthoses
		CAD–CAM orthoses
			Prescription writing for CAD-CAM  direct-milled orthoses
			Types of orthosis
			Prescription variations
				Flexibility
				Heel-cup height
				Width
			Postings
			Accommodations
			Problem solving
				Devices do not fit shoes
				Devices cut into the lateral side of the heel
				First metatarsal irritation
				Devices are too tight at the heel
				Irritation in the area of the medial longitudinal arch
				Insufficient control
	EEC DIRECTIVE ON THE MANUFACTURE  OF ORTHOSES
	SILIPOS
	HEEL ORTHOSES
	LATEX TECHNIQUE
	DIGITAL APPLIANCES FOR THE LESSER TOES
	SILICONES
	THERMOPLASTICS
		Hot-water plastics (Polyform, Aquaplast Hexcelite, X-Lite Plus)
			Low-temperature moulding
			Chairside technique
			Rapid remoulding
			No waste
			Complex construction
			Hexcelite (X-Lite Plus)
	CONCLUSION
	REFERENCES
18 Footwear
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	FUNCTION OF FOOTWEAR
		Primary function
		Secondary functions
		Completing a fashion
		Conducting specific tasks
		Compensating for an abnormality
	PARTS OF A SHOE
		The upper
			The toe box
			The toe cap
			The vamp
			The tongue
			The quarters
		The sole
			The insole
			Bottom fillings
			The welt
			The outsole
		The subsidiary parts
			The heel
			The shank
			The counter
			The backstay
	FEATURES OF A GOOD-FITTING SHOE
		Good retaining medium
		Close-fitting medial and lateral quarters
		Adequate width and depth in the toe box
		Correct length
		Correct width fitting
		Adequate heel seat
		Heel height no greater than 2 inches (5 cm)
		Broad heel base in contact with the ground
		Upper material made of leather or other natural material
	FOOTWEAR AND LAST TERMINOLOGY
		Tread line
		Toe spring
		Rigidity of the outsole
		Style of shoe
		Heel height
		Heel pitch
		Flare
	DESIRABLE FEATURES OF FOOTWEAR FOR SPECIFIC FOOT CONDITIONS
		Hallux abducto valgus
		Hallux limitus/rigidus
		The short, broad foot
		The long, mobile foot
		The highly arched foot
		The foot of the patient with  rheumatoid arthritis
		The foot of the patient with diabetes
	SIZE SYSTEMS AND SYSTEMS  OF MEASUREMENT
		The English size system
		The Continental size system
	COMMON FOOTWEAR STYLES
		Tie lace
		The Oxford shoe
		The Derby shoe
		The moccasin-style shoe
		The sandal
		The court shoe
		Sports shoes
		Boots
	WEAR MARKS AS AN AID TO DIAGNOSIS
		Normal wear
			The outsole and heel
			The insole (sock lining)
			The lining of the upper
			The upper
		Wear marks seen in association with common foot disorders
			Hallux limitus/rigidus
				The outsole and heel
				The insole (sock lining)
				The lining of the upper
				The upper
			Pes cavus
				The outsole and heel
				The insole (sock lining)
				The lining of the upper
				The upper
			Pes plano valgus
				The outsole and heel
				The insole (sock lining)
				The lining of the upper
				The upper
	THERAPEUTIC FOOTWEAR
		Introduction
		Indications for therapeutic footwear
	CLASSES OF THERAPEUTIC FOOTWEAR
		Stock surgical footwear
		Modular and bespoke footwear
		Features of the therapeutic shoe upper
		Features of soling in therapeutic footwear
	HEELS
		Heel height
	HEEL MODIFICATIONS
		Thomas heel
		Flared heels (floats)
		Combined heel and sole modifications
			Flares (floats)
			Wedges
		Contralateral wedging
		Through-sole and heel wedging
	MODIFICATIONS TO THE SOLE
		Lateral sole wedges
		Medial toe wedges
		Bars
		Rocker soles
			Adding rockers to existing footwear
		Shoe raises
			Measuring for the raise
			Types of raise
	ASSESSING THE FIT OF  THERAPEUTIC FOOTWEAR
	CONCLUSION
	REFERENCES
	FURTHER READING
19 Pain control
	CHAPTER CONTENTS
	KEYWORDS
	DEFINITION
	ANATOMY
	SOMATIC PAIN
	PHYSIOLOGY
		Peripheral nociceptor level
		Spinal level
		Supraspinal level
		Neuropathic pain
	PRINCIPLES OF PAIN MANAGEMENT
	THE WORLD HEALTH ORGANIZATION (WHO) THREE-STEP ANALGESIC LADDER
		Step 1
		Step 2
		Step 2 to 3
		Step 3
	ADJUVANT ANALGESICS
	ANTIDEPRESSANTS
	ANTICONVULSANTS
	ANTIARRHYTHMICS
	TOPICAL DRUGS
	NMDA RECEPTOR ANTAGONISTS
	REGIONAL ANALGESIA
	PHYSICAL THERAPY
	PSYCHOLOGY
	SPECIFIC CHRONIC PAIN CONDITIONS OF THE LOWER LIMB
		Complex regional pain syndrome
	REFERENCES
	FURTHER READING
20 Local anaesthesia
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION AND BACKGROUND
	BASIC CHEMISTRY AND PHARMACOLOGY
		Membrane electrophysiology
	CHOICE OF LOCAL ANAESTHETIC  AND DOSAGE
		Bupivacaine
		Levobupivacaine
		Etidocaine
		Lidocaine
		Mepivacaine
		Prilocaine
		Ropivacaine
	LOCAL AND SYSTEMIC COMPLICATIONS AND TOXICITY
		Local effects
		Systemic effects
			Central nervous system (CNS)
			Cardiovascular system
			Allergic reaction
			Hepatic and renal function
			Pregnancy
			Drug interactions
	LOCAL ANAESTHETICS IN PRACTICE
	SPECIFIC SITES
		Local infiltration
		The digital block
		The ray block
		Posterior tibial nerve
		The sural nerve (root index S1/S2)
		Saphenous nerve (root index L3/L4)
		The superficial peroneal (fibular) nerves (root index L4/L5, S1)
		The deep peroneal (fibular) nerve  (root index L4/L5, S1/S2)
		The popliteal block
	REFERENCES
	FURTHER READING
21 Nail surgery
	CHAPTER CONTENTS
	KEYWORDS
	PHENOLISATION
		Phenol
		History
	THE PHENOLISATION TECHNIQUE
		Total nail avulsion
		Partial nail avulsion
		Postoperative management
	SURGICAL PROCEDURES
		Winograd procedure
		Zadik’s procedure
		Frost procedure
		Terminal Syme’s amputation
	AVULSION USING UREA
	TREATMENT OF SUBUNGUAL EXOSTOSIS
	REFERENCES
22 Diagnostic imaging
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	IMAGING MODALITIES
	MAGNETIC RESONANCE IMAGING
	ULTRASOUND
	IMAGING MODALITIES UTILISING IONISING RADIATION: SAFETY AND LEGISLATION
	COMPUTERISED TOMOGRAPHY
	FLUOROSCOPY
	NUCLEAR MEDICINE IMAGING
	PLAIN RADIOGRAPHY
	COMMON RADIOGRAPHIC PROJECTIONS
		The dorsoplantar projection (also known as the anteroposterior view)
		Lateromedial oblique projection
		Mediolateral oblique projection
		Lateral projections
		Digital projections
		Sesamoid positioning
		Tarsal and ankle projections
	RADIOGRAPHIC CHARTING
	RADIOGRAPHIC ASSESSMENT AND INTERPRETATION
	DEVELOPMENTAL VARIANTS: NORMAL  AND ABNORMAL
	OSTEOCHONDRITIS OR OSTEONECROSIS?
	BONE TUMOURS
	BONES, JOINTS AND CONNECTIVE TISSUES
	FRACTURES
	REFERENCES
23 Podiatric surgery
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	PATIENT SELECTION FOR SURGERY
	PATIENT CONSENT
	DIGITAL DEFORMITIES
		Flexor stabilisation
		Flexor substitution
		Extensor substitution
		Adducto varus deformity
		Mallet toe
		Surgical treatment
			Excisional arthroplasty
			Arthrodesis
			Digital amputation
	HALLUX VALGUS
		Procedures
			Simple bunionectomy
			Distal metaphyseal procedures
			Midshaft procedures
			Basal procedures
			Hallux procedures
		Evaluation
	HALLUX VALGUS SYNDROME
	MORTON’S NEUROMA
	LESSER METATARSAL OSTEOTOMIES
	HALLUX RIGIDUS
	SESAMOID PROBLEMS
	SKIN PLASTIES
	REARFOOT SURGERY
	SUTURE MATERIALS
	SUTURE TECHNIQUES
		Simple interrupted sutures
		Mattress sutures
		Cross-over sutures
		Continuous sutures
	TISSUE HANDLING
	POSTOPERATIVE DRESSINGS
		The inner or contact layer
		The middle layer
		The outer layer
		The surface layer
		When to re-dress
	POSTOPERATIVE COMPLICATIONS
		Infection
		Swelling
		Dehiscence
		Haematoma
		Joint stiffness
		Hypertrophic scarring
		Transfer metatarsalgia
		Avascular necrosis
		Chronic regional pain syndrome
	REFERENCES
24 Principles of infection control
	CHAPTER CONTENTS
	KEYWORDS
	INFECTION TERMINOLOGY
		Pathogen
		Infection
		Infective dose
		Colonisation
		Carriers
		Sources of infection
		Vehicles of infection
		Cross-infection
		Portals of entry
		Portals of exit
		Normal flora of the body
	CHIEF SOURCES AND RESERVOIRS  OF INFECTION
		Endogenous sources
		Exogenous sources
			Infected or colonised people
			Infected or colonised animals
			Environmental sources and reservoirs
	TRANSMISSION OF INFECTION
		Direct transmission
		Indirect transmission routes
			Transmission by clinical items
			Airborne transmission
			Transmission by animals
			Faecal transmission
	HEPATITIS B VIRUS (HBV),  HEPATITIS C VIRUS (HCV) AND  HUMAN IMMUNODEFICIENCY VIRUS  (HIV) INFECTIONS
		Hepatitis B and hepatitis C viruses  (HBV and HCV)
		HIV and AIDS
		Implications for podiatrists
	VARIANT CREUTZFELDT–JAKOB DISEASE
	INFECTION CONTROL
		Terminology
			Sterilisation
			Disinfection
			Antisepsis
			Asepsis
	STRATEGIES AND METHODS OF CONTROL
		Elimination of sources and reservoirs
		Disruption of transmission routes
			Cleaning
			Disinfection
				Disinfection by hot water
				Disinfection by chemicals
			Types of chemical disinfectant
				Phenolic compounds
				Chlorine compounds
				Iodine compounds
				Alcohols
				Biguanide compounds
				Triclosan (2,4,4´-trichloro-2´-hydroxydiphenylether)
				Quaternary ammonium compounds
				Glutaraldehyde
				Hexachlorophane
			Disinfection of specific items
			Skin disinfection
				Hands
				Patients’ skin
			Sterilisation
				Steam at increased pressure
				Dry heat
				Glass bead sterilisers
	FURTHER MICROBIOLOGICAL ASPECTS OF CLINICAL WORK
		Protective clothing
		Aseptic technique
			Sterile fields
			Dressing changes
		Waste disposal
		Operating rooms
		Laboratory specimens
	INFECTION-CONTROL POLICIES
	REFERENCES
	FURTHER READING
25 Medical emergencies in podiatry
	CHAPTER CONTENTS
	KEY WORDS
	CLINICAL ASSESSMENT
	CLINICAL MONITORING
	EMERGENCY DRUGS AND EQUIPMENT
	PREDICTABLE EVENTS
		Cardiovascular: angina (ischaemic heart disease)/myocardial infarction
		Hypertension
		Dysrhythmia
		Heart valves/stents
		Respiratory
			Asthma
			Chronic obstructive pulmonary disease
		Endocrine
			Diabetes
				Hypoglycaemia
				Hyperglycaemia
		Hepatic/renal
			Renal failure
			Hepatic disease
		Central nervous system
			Transient ischaemic attack/stroke
			Epilepsy
				Minor fits
				Major fits
	UNPREDICTABLE EVENTS
		Vasovagal syncope
		Cardiac arrest
		Allergy/anaphylaxis
		Local anaesthetic toxicity
	SUMMARY
	FURTHER READING
26 Evolution and its influence on human  foot function
	CHAPTER CONTENTS
	KEY WORDS
	INTRODUCTION
	SOME LARGE-SCALE DIFFERENCES  BETWEEN THE HOMINOIDEA
		A comparison of gait cycles
		The functional adaptation of the midtarsal joint and the medial and lateral columns
		The functional transformation of  the subtalar joint
		Orientation of the medial  metatarsal–cuneiform joint
		Relative robusticity of the metatarsals
		Torsion of the metatarsal shafts
		Morphology of the metatarsal heads
	EVOLUTIONARY BASIS FOR SOME CLINICAL DISORDERS OF THE HUMAN FOOT
	REFERENCES
27 Health promotion and patient education
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	THE PODIATRIST’S ROLE AS A HEALTH PROMOTER/EDUCATOR
	PATIENT EDUCATION
	EVIDENCE-BASED PRACTICE
	CONCLUSIONS
	REFERENCES
28 Clinical governance
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	CHRONOLOGY
	BACKGROUND
	ASPECTS
		Quality planning
		Workforce planning and developing  the workforce
		Information technology
		Research
		Poor performance
		Learning from experience
		Risk management
		Consent and informed consent
	REFERENCES
29 Health and safety in podiatric practice
	CHAPTER CONTENTS
	KEYWORDS
	INTRODUCTION
	EFFECTIVE MANAGEMENT
	SUCCESSFUL HEALTH AND  SAFETY MANAGEMENT
	SAFETY CULTURE
	SAFE SYSTEMS OF WORK
	LEGAL DUTIES
	THE EMPLOYER’S RESPONSIBILITY TO VARIOUS PARTIES
		Employees
			Responsibilities of employees
		Trainees (i.e. student podiatrists on work experience or a placement)
		Health surveillance
		Visitors and the general public
		Trespassers
	HEALTH AND SAFETY POLICY
		General statement of intent
		Health and safety at work responsibilities
		Administration of health and safety  at work
	RISK ASSESSMENTS
		Record-keeping requirements
		Safe systems of work
		Accident procedures
		Working environment
		Control of chemicals
		Fire safety
		Physical agents/stored energy
		Plant and equipment
		Handling operations
		Risk assessment
			Principles of risk assessment
		Problem-solving and decision-making
		Evaluation and expression of risk
		Residual risk
		Expressions to identify risk
		Principles for risk control
		Basis for assessment
		Five steps to risk assessment
			Step 1. Look for hazards
			Step 2. Decide who might be harmed, and how
			Step 3. Evaluate the risks from the hazards and decide whether existing precautions are adequate or whether more is required
			Step 4. Record findings
			Step 5. Review assessments on a regular basis and revise when necessary
		Using risk factors to evaluate risk
			Likelihood of occurrence rating
		Expressing priorities for risk control
		Limits of reasonable practicability
			So far as is practicable
			Refinement of risk factors to help apply  control principles
		Checklist for risk assessments
		Generic risk assessments
	LEGAL REQUIREMENTS WHERE RISK ASSESSMENT IS SPECIFIED – SPECIFIC RISKS
		Noise at Work Regulations 2005
		Health and Safety (Display Screen Equipment) Regulations 1992  (as amended 2002)
		Manual Handling Operations Regulations 1992 (as amended 2002)
		Personal Protective Equipment at Work Regulations 1992 (as amended 2005)
		Control of Substances Hazardous to Health Regulations 2002
		Management of Health and Safety at Work (Amendment) Regulations 1999
		The Regulatory Reform (Fire Safety)  Order 2005
		Health and Safety (First Aid)  Regulations 1981
	REFERENCES
Index
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	B
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	D
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	F
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	H
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	Q
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