FOOT PROBLEMS IN THE

GERIATRIC POPULATION

Ingrid Kruse, DPMVA San Diego Healthcare System

UCSD School of Medicine

Common Foot Problems in the Geriatric Population

• Hallux Valgus (Bunion)• Ingrown toenails• Corns and Calluses• Plantar fasciitis (Heel pain)• Onychomycosis( Fungal nails)

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Bunions

Bunions: Conservative Treatment

Proper Shoe gearOTC Arch supportsCustom orthoticsBunion shields/padding

Extra depth shoes

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Indications Pain Activity Limitation Deformity Must Have: Good circulation Good Diabetes control Appropriate expectations

understand and accept risks

Bunions: Surgical Treatment

Plantar calluses

PLANTAR FASCIITIS

• Heel spur syndrome• Symptoms:

– Pain after rest / improves on walking– “Stone bruise”– Sharp pain– Pain at end of day

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Heel Pain (plantar fasciitis)

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Proper Shoe gear for Plantar fasciitis

• Shoes with solid heel counters• Shoes with thick mid-soles• Rocker bottom shoes

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Heel Pain (plantar fasciitis) stretching

• Feet turned• Back and knee straight• No bouncing• 5 x 30 seconds / twice a day

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Heel Pain (plantar fasciitis) icing

• 2-3 times per day x 10 minutes

• Try using re-useable device:Plastic bottle with 4 parts water and one part rubbing alcoholstore in freezer

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PLANTAR FASCIITIS

• What NOT to do:• Thin-soled shoes• Walking bare foot• Fire dancing

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PLANTAR FASCIITIS

Anti-inflammatory drugsInjections

cortisone & local anesthesiaSurgery – rarely indicated

Ingrown Nails

Genetic

Trauma

Shoes

Improper cutting

Partial Nail Removal

• Resolves infection• For recurrent

problem:• Kill the root by

chemical or Surgical method

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Surgical Treatment Matrixectomy : Permanent removal of nail

Effective/Safe High satisfaction

• 89% Phenol

Ingrown Nails

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Signs & Symptoms Usually Pain Free Difficult to cut Nails can be thick, loose or

discolored Can be ingrown

Onychomycosis

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Causes Fungus invades nail bed

Previous injury to nail

Genetic factors Reduced Immune

system

• Fungal nails

Onychomycosis

Onychomycosis

• TOPICAL TREATMENTS:

• 2% Miconazole tincture (Fungoid Tincture)• 10 % Efinaconazole ( Jublia)• 5% Tavaborole ( Kerydin)

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Oral Terbinafine (Lamisil)

Most effective of the oral agents 250 mg q day x 3 months Reccurrence:

1yr = 15% 2yrs = 22%

Must monitor liver function

Onychomycosis

Onychomycosis

• Regular debridements and thinning out of the nails

• Homeopathic :• Tea Tree oil, Vick’s Vapor rub• Diluted vinegar soaks• Diluted bleach soaks

TINEA PEDIS

• “Athlete’s Foot”• Cracks between the toes• Blisters in arch area or along side of foot• May be itchy or painful• Often just looks like dry scaly skin

ATHLETE’S FOOT

• TREATMENT:• Lamisil creme• Spectazole creme• Lotrimine• Tinactin

• KEY: use TWICE a day!

Other Foot Problems in the Geriatric Population

• Peripheral Arterial Disease• Peripheral Neuropathy• Diabetes• Malignancies• Psoriasis• Gout

Peripheral arterial disease

Improper nail trimming

What is the diagnosis?

Walking barefoot in the House

Puncture Wound in Diabetic

Rusty Nail

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Make Foot Care Part of Your Daily Routine

• Examine your feet every day. • Check your shoes before you put them on. • No “bathroom” surgery.• No barefoot walking, use proper shoes• Get early treatment for any foot problem,

even a minor one.

Thank You!