By Michael E. Edmonds, Alethea V. M. Foster, Lee Sanders
3rd writer, Lee. J. Sanders, is the dep. of Veterans Affairs clinical heart, Lebanon, PA. deals sensible and medical recommendation at the administration of long term foot difficulties in individuals with diabetes. Discusses prognosis and therapy, either scientific and surgical. fine quality colour photographs illustrated many of the problems. DNLM: Diabetic Foot--diagnosis.
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Extra resources for A Practical Manual of Diabetic Foot Care
Malignant melanoma may also present as a discoloured area under the nail plate. Irregular discolouration of the nail bed and plate and progressive destruction of nail are seen. Some melanomas are not associated with pigment (Fig. 9). Patients should be referred urgently to the dermatologist. Subungual exostosis. An acutely painful cherry red spot develops under the nail plate. A lateral X-ray reveals bony outgrowth of the distal phalanx. The treatment is surgical. Fungal infections (tinea pedis) These can present in several ways: • Dry, scaly plantar, often in a 'moccasin-like' distribution • Acute vesicular • Interdigital, with moist, cracked areas which may be sore, itchy and sometimes malodorous, and are associated with whitish, rubbery, macerated skin, and can undergo erosion.
In severe cases, nail avulsion with phenolization of the nail bed, as shown in Fig. 6 can provide a permanent solution. Nail infections Onychomycosis (fungal nail). When fungal infection invades the nail plate it first causes white or yellowish discolouration of a patch of nail, which subsequently becomes thickened and friable. The majority of infections are caused by moulds called dermatophytes, or by yeasts, notably Candida albicans. There are four distinct types of onychomycosis: • Distal and lateral subungual onychomycosis, which affects toe nails twice as commonly as finger nails.
Chronic paronychia results in the periungual tissues appearing erythematous and oedematous. The infection extends to the nail plate which may develop yellowishgreen or yellowish-brown pigmentation. Chronic paronychia is frequently caused by infection with Candida albicans and the treatment is with terbinafine or itraconazole, as described above. The feet should be kept dry. Stage 1: the normalfoot 23 was cut back to reveal an area of necrosis involving the nail bed. Differential diagnosis was necrosis caused by infection or purely by hydrostatic pressure from a collection of blood under the nail plate.
A Practical Manual of Diabetic Foot Care by Michael E. Edmonds, Alethea V. M. Foster, Lee Sanders