Clinics in podiatry最新文献

It is impossible to delineate, in the short space provided, the entire spectra of possible and potential podiatric manifestations of acute and chronic neurologic disease. An attempt has been made to delineate the neuroanatomic, neurophysiologic, etiologic, and diagnostic procedural knowledge required to fully comprehend, evaluate, and manage neurologic complaints in presenting patients. By following a specific outline for evaluation, a functional and meaningful differential diagnosis can be formulated. By properly employing the ancillary procedures discussed, a correct diagnosis will be attained. Concurrently, at this point in evaluation, a grasp of the location and gravity of the discovered lesion will allow us to intelligently treat or refer the patient for proper management. Since the vast majority of neurologic manifestations involve and cross-effect several bodily systems, not all neurologic diagnoses are or will be easy. Only through a constant awareness of the mechanisms, symptomatology, clinical findings, and a careful, precise, and thorough neurologic evaluation and test selection will these patients be helped.

Several terms are used interchangeably with the word "keratosis." All signify some form of thickening of the stratum corneum. This article outlines the process for diagnosis and treatment of these keratoses.

Podiatric surgeons no longer care only for patients who are systemically well. The foot surgeon must also become intimately familiar with the diseases and conditions which may affect his patients.

Relationships to the gastrointestinal system can be found in the diagnosis and treatment of problems affecting the pedal extremity. This is due to the fact that parts of the gastrointestinal tract are derived from the same germ layer as portions of the foot. An awareness of these relationships can be useful in determining the etiology, establishing a diagnosis, and forming a plan for management.

This article has attempted to alert the podiatric medical practitioner to those endocrine disorders which have pedal manifestations. With the clinical information presented here, the podiatrist is in a unique position to identify early signs of endocrine disease. By doing so, the podiatric practitioner may play a vital role as a member of the primary care team.

The cases and conditions reported in this article are but a minute sampling of the multitude of systemic conditions in which foot shape and position are valuable clues to associated serious illnesses in children. The podiatrist can contribute greatly by establishing important early diagnoses in these cases. Many times the podiatrist is the first-contact physician because of the early foot involvement. The podiatrist can make a valuable contribution to the health of children by recognizing early symptoms.

Ulcers of the foot and ankle secondary to blood dyscrasias may become more common as a result of modern medicine's ability to keep patients alive long enough to become victims of chronic disease. Also, many pharmaceutic agents have, among their side effects, the ability to produce hematologic complications. The physician should consider that hematologic disorders may be among the etiologic agents responsible for foot and ankle ulcers.

The cardiovascular system has multiple implications in the podiatric patient. The examination should begin with a complete and careful history. The physical examination should be thorough. Noninvasive evaluation should be performed as indicated with both a static and functional component. Cardiac disease should be investigated in all patients with a history or physical findings consistent with this disorder, such as blue toe syndrome, palpitations, or chest pain.

We feel that surgical intervention for heel spurs must be used with caution after a strong program of conservative measures is tried. We have learned that it is helpful to inform patients of the complexity of heel pain and that, even with surgery, their discomfort may continue for some time. We also have always advised patients that being overweight increases their pain. In light of this study, we will probably make stronger statements on the importance of losing excess weight. When people can maintain a desirable weight, heel spur syndrome surgery can produce uniformly good results. The key is in the careful selection of cases.