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Leg, foot and nail disease in the elderly
Published in Robert A. Norman, Geriatric Dermatology, 2020
M. Alam, R. K. Scher, P. I. Schneiderman
Digital deformities of the feet are hallux valgus (bunion), hallux limitus and hammer toe contractures or claw toes4,66. Bunions entail a lateral deviation of the great toe with medial prominence of the metatarsal head at the first metatarsophalangeal joint. Hallux limitus is an osteoarthritis of the first metatarsophalangeal joint. Severe hallux limitus culminates in hallux rigidus, in which the patient finds it difficult to propel the foot forward when walking because of diminished joint motion. Treatments for bunions and related disorders are ice compresses, wider shoes, shoes stretched by a shoemaker, bunion shields and surgery. With hallux limitus, conservative treatment may be of limited benefit. Like bunions, hammer toe contractures and claw toes are exacerbated by narrow shoes. Hammer toe contractures result from the hyperflexion of small toes and the resulting curling of the toes. With age, increasingly rigid and painful contractures occur in association with hyperkeratotic lesions. For relief, patients may try moleskin, corn pads, toe splints, lamb’s wool, open toe shoes and emolliation. Severe claw toes and hammer toes may require surgical correction.
Nail in elderly population
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
A. S. Savitha, B. M. Shashikumar
Hammer toe is a deformity arising through increased extension at the metacarpophalangeal joint and corresponding flexion at the proximal interphalangeal joint. In the extreme form, the tip of the digit is directed downwards and develops an “end corn” beneath the pulp of the toe just below the nail plate edge associated with thickening of the nail plate and the distal nail bed. This is called claw deformity.
Foot Care
Published in Susan Carmody, Sue Forster, Nursing Older People, 2017
Hammer toes and claw toes are among the most common foot complaints in older people, and can lead to the development of corns on the dorsum of the interphalangeal joints and calluses under the metatarsal heads.
Advances in pharmacotherapy for diabetic foot osteomyelitis
Published in Expert Opinion on Pharmacotherapy, 2021
Raju Ahluwalia, Jose Luiz Lázaro-Martínez, Ines Reichert, Nicola Maffulli
The diagnosis of infection is usually clinical (Table 1). Microbiological characterization is essential, as it allows identification of the bacteria involved and to plan appropriate antibiotic treatment. A DFO is the consequence of the soft tissue infection arising from a DFU spreading into bone, involving the cortex first and then the bone marrow. The identification of necrotic bone, which can be a stigma of infection, is an important prognostic marker, and healing requires viable bone, and thus resection of all dubious material to fresh bleeding tissue or clear margins [6,18]. Septic arthritis is seen acutely and is beyond the scope of this article. However, chronic issues that result from it, such as hammer toe ulceration are. Recurrence of a DFU or the inability to achieve healing is suggestive of a chronic DFO, and chronicity is defined by not healing within the expected time [6].
Preoperative Japanese Society for the Surgery of the Foot Lesser toe score and erythrocyte sedimentation rate influence wound healing following rheumatoid forefoot surgery
Published in Modern Rheumatology, 2021
Koji Ohta, Jun-ichi Fukushi, Satoshi Ikemura, Satoshi Kamura, Hisa-aki Miyahara, Yasuharu Nakashima
In the present study, there was no significant difference in the alignment score on the JSSF lesser toe scale between the two groups (0.5 in the Healed, and 1.8 in the Delayed groups). An alignment score of 15 indicates good alignment, a score of 8 indicates mild-to-moderate malalignment that is easily correctable, and a score of 0 indicates severe malalignment that is uncorrectable [9]. However, a floor effect should be taken into account, because the majority of the patients had uncorrectable hammer toe. Therefore, we sought to quantitatively evaluate the uncorrectable deformity by measuring the height of 2nd PIP, which was not associated with a delay in wound healing. However, a previous study reported an association between delayed wound healing and preoperative dorsoplantar deformity of the lesser toes following rheumatoid forefoot surgery [4]. Whether the degree of hammer toe deformity affects wound healing should be determined in future studies, using a reliable, quantitative method of evaluation. Although not significant, the function score on the Lesser toe scale showed a tendency to be lower in the Delayed group than the Healed group (13.7 ± 7.9 and 18.0 ± 9.3, respectively, p = .085). Thus, given that the Lesser toe total score was significantly lower in the Delayed group, we believe that the total severity of rheumatoid forefoot disorder is associated with delayed wound healing.
Experiences of foot health in patients with rheumatoid arthritis: a qualitative study
Published in Disability and Rehabilitation, 2022
Anne-Marie Laitinen, Carina Boström, Sasu Hyytiä, Minna Stolt
Rheumatoid arthritis (RA) is long-term immune-mediated inflammatory rheumatic disease in which foot problems are prevalent. The onset of the disease is commonly diagnosed on the basis of hand and foot pain, with problems identified in the forefoot [1]. Due to the damage that RA causes to the joints in the foot, forefoot disorders (such as flat foot, hallux valgus, hammer toes and overlapping toes) and hindfoot disorders (such as valgus heel) are common [2]. It is estimated that patients with RA have twice as many foot problems as people in the general population [3]. Many of these problems are associated with disability; thus, they hamper safe walking [4] and possibly reduce patients’ independence.