Leg, foot and nail disease in the elderly
Robert A. Norman in Geriatric Dermatology, 2020
Hyperkeratotic lesions (Figures 5–8) occur focally and diffusely over bony prominences and areas of increased friction54. Hyperkeratosis is a normal reaction of the skin to internally or externally applied pressure55 and can present as a callosity, callus, or corn56. According to one definition, a callosity is a plaque caused by repeated friction or pressure; a corn is a sharply demarcated callosity over a bony prominence, especially of the hands or feet, that is painful; and a callus is a broad, diffuse hyperkeratosis under the metatarsal heads (Figures 5–8)57. Soft corns between the fourth and fifth toes may be extremely painful and accompanied by maceration and cellulitis58,59. The soles of the feet in the elderly are vulnerable owing to fat pad atrophy, asymmetric pressure load and impaired vascular supply60,61. Hyperkeratoses on the sole can erode to form ulcers, with up to 30% of leg ulcers in the elderly occurring on the foot or sole. In patients with vascular or neurologic impairment, hyperkeratoses should be debrided to see if they conceal a deep ulcer or osseous involvement54. For women especially, hyperkeratotic and other foot problems are frequently related to a lifetime of wearing shoes that are too small and narrow4,62.
The Ankle and Foot
Louis Solomon, David Warwick, Selvadurai Nayagam in Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
In mallet-toe it is the distal IP joint that is flexed. The toenail or the tip of the toe presses into the shoe, resulting in a painful callosity. If conservative treatment (chiropody and padding) does not help, operation is indicated. The distal IP joint is exposed, the articular surfaces excised and the toe straightened; flexor tenotomy may be needed. A thin K-wire is inserted across the joint and left in position for 6 weeks to hold the joint until fusion is achieved.
Lower limb symptoms and signs
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Continual pressure and friction on small areas of the skin of the foot caused by poor-fitting shoes or skeletal deformities stimulate thickening of the skin. A patch of thickened hyperkeratotic skin is called a callosity. It is often called a corn if it is pushed into the skin so that it appears to have a deep central core. These can also be painful when squeezed, making the differential diagnosis from a plantar wart difficult.
Relationship of callosities of the forefoot with foot deformity, Health Assessment Questionnaire Disability Index, and joint damage score in patients with rheumatoid arthritis
Published in Modern Rheumatology, 2020
Takeshi Mochizuki, Koichiro Yano, Katsunori Ikari, Ryo Hiroshima, Mina Ishibashi, Ken Okazaki
This study has several limitations. First, we evaluated only the relationship of callosities of the forefoot with hallux valgus and flatfoot. Hindfoot deformity has been indicated as a factor related to forefoot deformity in RA [8,9,27]. However, in this study, a hindfoot alignment view was not performed. Moreover, in the study, we investigated MTP joints in a limited manner. Second, we could not investigate the degree of the callosities. Therefore, regardless of the degree, we diagnosed the presence of a callosity if it fell within the definition. Finally, this study was cross-sectional. Based on our results, the onset of callosities was related to disease duration, HAQ-DI, and TSS of foot by univariate analysis. The relationship between joint damage and integral of disease activity was also assessed. In this study, no significant difference was detected in the DAS28-ESR between the two groups. Moreover, the time of occurrence of hallux valgus and flatfoot was unknown. Accordingly, we think that a longitudinal study is necessary to clarify and further characterize the factors associated with callosities of the forefoot. Despite these limitations, this study suggested the cutoff values and OR of hallux valgus and flatfoot for the callosities of the forefoot on X-rays taken in daily clinical practice in patients with RA.
Proximal metatarsal wedge osteotomy for metatarsus primus elevatus associated with rheumatoid forefoot deformity: a case report
Published in Modern Rheumatology Case Reports, 2019
The right foot was treated with proximal plantar flexion wedge osteotomy of the first metatarsal [9,10] and distal oblique shortening osteotomies of the lesser metatarsals [11]. The size of the wedge to be removed from the base of the first metatarsal was determined preoperatively using the method of Niki et al. [12], in which the distal end of its head came in contact with the proximal end of the proximal phalanx. First, the adductor tendon was released from the lateral aspect of the lateral sesamoid and the base of the proximal phalanx. Next, the medial capsule of the first metatarsophalangeal joint was opened with a Y-shaped incision. The medial eminence was then resected. Next, the wedge was removed from the base of the first metatarsal. During the procedure, we adjusted the sagittal inclination of the osteotomy surface so that the first metatarsal head could touch the flat plate, which simulates the ground. Finally, the osteotomies were fixed with Kirschner (K-) wires, and the medial capsule was sutured in a V shape (Figure 2(B)). The first interphalangeal joint was not treated surgically because the transfer of the body weight load from the interphalangeal joint to the head of first metatarsal resulting from the first metatarsal wedge osteotomy was expected to reduce pain at the callosity. Postoperatively, the foot was placed in a bulky dressing with a short leg cast. The patient was allowed to walk with weight bearing on the heels. K-wires used for the lesser toes were removed 3 weeks after surgery. The patient was advised to wear shoes with arch support until 6 months after surgery. When bony fusion was obtained, K-wires used for the first metatarsal were removed.
Changes in radiographic findings and plantar pressure distribution following forefoot reconstructive surgery for patients with rheumatoid arthritis
Published in Modern Rheumatology, 2020
Hyunho Lee, Hajime Ishikawa, Tatsuaki Shibuya, Chinatsu Takai, Yumi Nomura, Daisuke Kobayashi, Asami Abe, Hiroshi Otani, Satoshi Ito, Kiyoshi Nakazono, Keinosuke Ryu, Takao Ishii, Shu Saito, Kaoru Abe, Akira Murasawa
This study was performed on RA patients who underwent Swanson implant arthroplasty for the 1st MTP combined with shortening oblique osteotomy at the 2nd through 5th metatarsal necks at our hospital from April 2012 to March 2016. Patients who had history of previous foot surgery and severe hip, knee or ankle joint destruction equal to or higher than Larsen grade III were excluded, because it was thought that malalignment of the lower limbs affected plantar pressure in patients with severe joint destruction in the hip, knee, and ankle joints. Surgical reconstruction was indicated to the patients with persistent painful callosity in the forefoot as an alternative to intensive foot care, which included shaving of the callosity and applying adequate footwear. There were 55 feet in 43 patients, consisting of 51 feet in 39 female patients and four feet in four male patients (group Sw). All patients in the study underwent shortening oblique osteotomy at the 2nd through 5th metatarsal neck [6]. In addition, the postoperative results in group Sw were compared with the values obtained from two control groups: group NS, consisting of 75 feet in RA patients without scheduled forefoot surgery, and group HC, consisting of 24 feet with no callosities in healthy female control subjects. The patients in group NS were recruited from RA patients who hospitalized for the purpose of upper extremity surgery or disease control and had no callosities, no dislocations of the MTPs and no severe hip, knee or ankle joint destruction equal to or higher than Larsen grade III. Additionally, RA patients with a hallux valgus angle (HVA) of 0–20° were chosen for group NS. This study was approved by the ethics committee of our institution.