Click here to reflect on this article and add notes to your CPD Organiser on MIMS Learning
This 70-year-old woman was born with significant abnormalities of her feet. She had one toe missing, with gross clawing of the others. She had managed extremely well, although she did say that she had been quite unhappy as a young woman, because she had been unable to wear any kind of fashionable footwear. More recently, she had been offered surgery but decided against it. She was not restricted in terms of her ability to walk.
This young man was starting to have problems with footwear. He was tall and had very long toes. The proximal interphalangeal joint of his second toe was now fixed. He was referred to physiotherapy and the assessment confirmed that he has significant tightness in the calf, with some shortening of the tendons. Over years, he had worn flip flops much of the time and this lack of support, with clawing to hold them on, had not helped. He has been given a series of stretching exercises to alleviate the symptoms, but he may need surgery in future.
There are ever-increasing numbers of elderly patients with oedema. This 80-year-old woman had multiple problems, all aggravating her situation. She was obese and had chronic venous insufficiency, with heart failure, leading to her spending all day in a chair. Her legs had been swollen for years and although she had used support hosiery in the past, she could no longer manage to put on stockings because of her arthritic hands. Her skin was clearly at risk of ulceration, but her daughter was very diligent with the use of emollients, so she had avoided this complication.
This is a disease that we usually associate with deformities of the hands. Clearly, other areas of the body are also affected. This young woman in her 30s had suffered for many years, with gross deformities. Sadly, her disease had been left to run riot in its early stages, leading to severe inflammation and joint destruction. She had several operations on her feet and more are planned. She is now on DMARD therapy, which has slowed the progression of her condition.
This woman shows the changes as hallux valgus progresses over many years. She has a fairly modest bunion, but the deviation of the great toe is quite significant, pressing in on the adjacent toes. These are squeezed and starting to develop fixed flexion deformities and considerable discomfort. She opted to have surgery to try to improve the pain. There are many options, ranging from relatively simple operations with a higher recurrence rate, to more complex, definitive surgery.
This woman complained of sore feet. She had been neglecting herself for some time, and this picture shows a rather raw appearance following the removal of some macerated skin. She had a fungal infection, which had then developed a secondary staphylococcal infection. Treatment involved antifungal cream, oral antibiotics and most importantly, advice on footcare and shoe selection to avoid future problems.
This 32-year-old insulin-dependent diabetic developed a relatively trivial looking infection of the little toe. She was treated with antibiotics, but the infection did not respond. She had unfortunately not looked after herself over the previous years of her illness, and already had significant vascular and renal disease. Eventually, it was decided that surgery to remove the end of the toe was the only option. This underlines the critical importance of footcare in all diabetic patients.
This young man had recurrent problems with ingrowing toenails. He had repeated infections and developed significant overgrowth of granulation tissue on both sides of the nail. Silver nitrate was applied to try to control the overgrowth and he was prescribed another course of antibiotics. It was decided that the best option would then be surgical removal of the nail, with appropriate advice regarding the cutting technique for his other nails.