Foot Problems in Older People Assessment and Management

250 FOOTWEAR CONSIDERATIONS Journal of the American Geriatrics Society 1991; 39: 114. Clarke TE, Frederick EC, Hamill CL. The effects of 1194–1200. shoe design parameters on rearfoot control in 107. Whipple RH, Wolfson LI, Amerman PM. The rela- running. Medicine and Science in Sports and Exer- tionship of knee and ankle weakness to falls in cise 1983; 15: 376–381. nursing home residents: an isokinetic study. Journal of the American Geriatrics Society 1987; 35: 115. Nigg BM, Morlock M. The influence of lateral heel 13–20. flare of running shoes on pronation and impact 108. Ottaviani RA, Ashton-Miller JA, Kothari SU et al. forces. Medicine and Science in Sports and Exercise Basketball shoe height and maximal muscular resis- 1987; 19: 294–302. tance to applied ankle inversion and eversion moments. American Journal of Sports Medicine 116. Lord SR, Rogers MW, Howland A et al. Lateral 1995; 23: 418–423. stability, sensorimotor function and falls in older 109. Robbins SE, Waked E, Rappel R. Ankle taping people. Journal of the American Geriatrics Society improves proprioception before and after exercise. 1999; 47: 1077–1081. British Journal of Sports Medicine 1995; 29: 242–247. 117. Williams A. Footwear assessment and management. 110. Matsusaka N. Control of the medial-lateral balance Podiatry Now 2006; May: S1–S8. in walking. Acta Orthopedica Scandinavica 1986; 57: 555–559. 118. Fortinsky RH, Iannuzzi-Sucich M, Baker DI et al. 111. Gauffin H, Tropp H. Postural control in single limb Fall-risk assessment and management in clinical stance strategies for correction. Journal of Human practice: views from healthcare providers. Journal of Movement Studies 1994; 26: 267–278. the American Geriatrics Society 2004; 52: 112. Hoogvliet P, Duyl WAV, Bakker JVD et al. A model 1522–1526. for the relation between the displacement of the ankle and the centre of pressure in the frontal plane, 119. Rossi W. The frustration of ‘sensible’ shoes. Journal during one leg stance. Gait and Posture 1997; 6: of the American Podiatry Association 1980; 70: 39–49. 257–258. 113. Hoogvliet P, Duyl WAV, Bakker JVD et al. Variations in foot breadth: effect on aspects of 120. Janz NK, Becker MH. The health belief model: a postural control during one-leg stance. Archives of decade later. Health Education Quarterly 1984; 11: Physical Medicine and Rehabilitation 1997; 78: 1–47. 284–289. 121. Dunne RG, Bergman AB, Rogers LW et al. Elderly persons’ attitudes towards footwear – a factor in preventing falls. Public Health Reports 1993; 108: 245–248. 122. Nancarrow S. Footwear suitability scale: a measure of shoe fit for people with diabetes. Australian Journal of Podiatric Medicine 1999; 33: 57–61.

Index Note: Page numbers in italics refer to figures. ABCD mnemonic, 92 Alternating pressure devices (APDs), Arthrodesis Abductor hallucis, 152 134 ankle, 205, 207 Achilles Foot Screening Project, 3, 79, hallux valgus, 157 Amorolfine, 101, 102 osteoarthritis, 207 84 Amputation, toe proximal interphalangeal joint, 186 Achilles reflex, 40, 41 tibialis posterior dysfunction, 199 Achilles tendinopathy, 202–4 lesser toe deformities, 168 onychocryptosis, 106 Arthroplasty, implant, 163–4, 164 aetiology, 202–3 Ankle Articulated hindfoot orthoses (HFO- assessment and diagnosis, 203–4 age-related physiological changes in definition, 202–3 A), 227 treatment muscles, 21 Assessment, 29–56 manual muscle testing, 45, 46 conservative, 204 range of motion, 43, 44 diagnostic imaging, 30, 47–8 surgical, 204 reflex, 40 footwear, 30, 53, 53–5, 54, 55 Achilles tendon, age-related Ankle problems functional, 30, 48–53 physiological changes, 20 effect of age on, 20 initial interview, 29–34, 30 Achillodynia see Haglund’s deformity falls, 8 outcomes of treatment, 55–6 Acral lentiginous malignant melanoma, prevalence, 2, 4 systems examination, 30, 34–47 94 Ankle–brachial index (ABI) Asteatotic dermatitis, 80, 80 Acrochordons, 86, 88 compression therapy, 135 Auspitz’s sign, 82 Acrocyanosis, 124–5 peripheral arterial assessment, Autografts, 137 Acroexfoliative dermatitis, 81 Axons, age-related physiological Acrokeratosis paraneoplastica, 68 37–8 Acropachy see Nail clubbing Ankle–foot orthoses (AFO), 218, changes, 17 Actin filaments, 20 Azoles Actinic keratosis, 68, 92, 92 226–7, 227 Activities of daily living, 49 and balance, 228 onychomycosis, 101, 102 Adductor hallucis, 152 osteoarthritis, 207 tinea pedis, 85 Adductovarus toe, 166 tibialis posterior dysfunction, Advanced activities of daily living Balance (AADLs), 49 199 foot orthoses as an aid to, 228–9 Age, risk factors, 6 Anti-inflammatory medications, 204 and footwear, 241–4 Aged care facilities, research studies, 2 Arch index, 42, 42, 43 Age-related physiological changes, Arsenical keratosis, 68, 93, 93 Balloon patching, 239–40 13–22 Arterial disorders, 121–6 Basal cell carcinoma, 92, 93, 94 integumentary system, 13–16 muscular system, 20–2 acute arterial occlusion, 123 differentiation from subungual peripheral sensory system, 17–18 cold-associated conditions, 123–6 exostoses, 109 peripheral vascular system, 16–17 peripheral arterial disease, 121–3, skeletal system, 18–20 Basal osteotomies, 156–7, 157 Akin procedure, 155, 155 122, 123 Basic activities of daily living (BADLs), Alcohol, keratotic lesions, 71 vasospastic disorders, 123–6 Alginate dressings, 133 Arterial ulcers, 129–30 49 Allografts, 137 dressings, 133 Bazex’s syndrome, 68 Allopurinol, 170 guidelines for the management of, Bead dressings, 133 Allylamines Beau’s lines, 15 onychomycosis, 101 139 tinea pedis, 85 Arteries medication use-associated, 114, 114 age-related physiological changes, 16–17 systemic diseases-associated, 111, 113, 113 assessment of, 36–8 stiffness measurement, 17 Bespoke footwear, 240, 240 Arthritic conditions, effect on gait, Bioengineered human skin equivalents, 50 137 Biopsy, wound, 138

252 Index Black heel, 91, 92 Capillaries Collagen, age-related physiological Blood supply, age impaired, 15 age-related physiological changes, changes, 14 Blue naevus, 91 17 Body mass index (BMI), 193 thrombosed, 86, 87 Collagen cross-linking, age-related Bone, age-related physiological physiological changes, 19 Carbon paper, 51 changes, 18, 19 Cartilage, age-related physiological Collagen fibrils, age-related Bone scanning physiological changes, 19 changes, 19 in general, 48 Cast orthoses, 218, 225–6, 226 Collateral ligament rupture, 185 plantar heel pain syndrome, 193 Cautious gait, 49, 50 Colonisation, 137 Bonney-Kessel osteotomy, 163, 164 Cellulitis, 83, 84 Combined rockers, 238 Bowen’s disease, 93, 93 Cerebellar ataxia, 49, 50 Community-based studies, 3–5 Bruising, 15 Chairside orthoses Bruits, 37, 38 in other countries, 5 Buerger’s test, 37 crescent pad, 218–19, 219 in the UK, 4–5 Bulla, 35 foam sleeves, 220 in the USA, 3–4 Bullous tinea pedis, 84 horseshoe pad, 218, 219 Co-morbidities, risk factors, 6–7 Bunion shield, 224 interdigital wedge, 219, 219–20 Compound melanotic naevocellular Bunionette, 168, 168–9 metatarsal shaft pad, 221, 221–2 prevalence, 4 plantar calcaneal pad, 221, 222 naevus, 91 Bunions see Hallux valgus plantar cover, 220, 221 Compression bandaging Bursal inflammation, 149, 150 plantar metatarsal pad, 220–1, Bursectomy, 201 chronic venous insufficiency, 127 Bursitis 221 foot ulcers, 134–5 plantar calcaneal, 194 retrocalcaneal pad, 222 lymphoedema, 128–9 retrocalcaneal see Haglund’s saddle pad, 219, 220 Compression stockings, 135 silicone orthodigita, 222 Computed tomography (CT), 48 deformity toe prop, 219, 219 Consequences of foot problems, 7–9 Buttress appliance, 219, 219, 223 toe sleeve, 219 Constant low-pressure devices valgus pad, 221, 222 Cadence, 50 Cheilectomy, 163, 164 (CLPDs), 134 Calcaneal body index, 200, 200 Cherry haemangioma, 90 Contamination, 137 Calcaneal inclination angle (CIA), 200, Cheshire Foot Pain and Disability Contoured insoles, 224–5, 225 Corn plasters, 70 200 Survey, 5 Corns Calcaneal osteotomy Chevron procedure, 156, 156, 163 Chilblains, 125, 125–6 classification and clinical Haglund’s deformity, 201, 202 Cholesterol, seed corns, 65 presentation, 61–2 tibialis posterior dysfunction, 199 Chondrocytes, 19 Calcaneal petechiae, 91, 92 Chondroitin sulphate, 19 debridement, 69, 69–70 Calcaneal spurs, 47, 192 Chondroma, 195 distribution patterns, 63 plantar heel pain syndrome, 192, Chronic plaque psoriasis, 81–2, 82 footwear assessment, 53, 236 Chronic venous insufficiency see gender differences, 6 193 interdigital wedge, 219 Calcaneus Venous insufficiency, chronic prevalence, 2, 3, 4, 5 Chronic winter itch, 80, 80 topical treatment, 70 insufficiency fracture, 48 Ciclopirox, 101, 102 Cortical bone, age-related physiological osteoarthritis, 205, 205 Circulatory problems prevalence, 2 stress fracture, 194 Clavus see Corns changes, 18 Calf stretching, 196 Claw toes, 165, 166 Corticosteroid injection Calf-squeeze test, 203 Calluses, 62 prevalence, 4 Achilles tendinopathy, 204 classification and clinical surgical treatment, 168 Haglund’s deformity, 201 toe prop, 219 hallux limitus/rigidus, 162 presentation, 61–2 Clifton Assessment Procedure for the intermetatarsal neuroma, 183 common patterns, 63 plantar heel pain syndrome, 196 debridement, 69–70 Elderly study, 5 tibialis posterior dysfunction, 199 footwear assessment, 236 Clock Drawing Test (CDT), 31, 31 see also specific corticosteroid gender differences, 6 Closing wedge osteotomy, 156, 157 Corticosteroid use, Achilles heel, 70, 70 Clostridium spp., 83 orthotic therapy, 71, 71–2 Clubbed nails see Nail clubbing tendinopathy, 203 plantar pressure measurement, 65 Cock-up hallux, 4 Cortisone injections prevalence, 2, 3, 4, 5 Cognitive status assessment, 31, 31 topical treatment, 70, 70 Cold exposure, conditions related to, Achilles tendinopathy, 204 Candidal onychomycosis, 100 Haglund’s deformity, 201 123–6 intermetatarsal neuroma, 183 plantar heel pain syndrome, 196 Corynebacterium spp., 83 Coughlin & Shurnas classification, 158, 159

Index 253 Cramps, nocturnal, 37 Drugs see Medication use; specific drug First step pain, 192 Crescent pad, 218–19, 219 Dry skin see Skin, dry Fissures, 15 Crescentic osteotomy, 156, 157 Dumbbell pad, 219, 219–20, 223, 224 Flat feet, 197 Crest pad, 219, 219, 223 Dunedin Program, 3–4 Critical limb ischaemia, 37, 122 Dynamometers, 44–6 footwear assessment, 54 Cross-over toe see Over-riding toe Dysacromelia see Nail clubbing hallux valgus, 152 Cryotherapy, verrucae, 86 prevalence, 3, 4 Cucumber heels see Haglund’s Eccrine glands, age-related tibialis posterior dysfunction, 199 physiological changes, 15 Flexor digitorum brevis testing, 45 deformity Flexor digitorum longus testing, 45 Cutaneous horns, 86, 88 Eczema, 80, 80–1 Flexor hallucis brevis testing, 45 Cutaneous tags, 86, 88 Eczema craquelé, 80, 80 Flexor hallucis longus, 151 Cyanoacrylate adhesives, 70 Edinburgh Claudication Questionnaire, testing, 45 Cystic basal cell carcinoma, 93 Fluconazole, 102 Cysts, 85–94 37 Fluoroquinolone antibiotics, 203 Education, risk factors, 7 Foam dressings, 133 definition, 35 Egyptian foot, 104 Foam sleeves, 220 see also specific cyst Elastin, age-related physiological Fontaine classification, 36 Foot Darier’s disease, 68 changes, 14, 16–17 ability to perform care, 52–3 Debridement see Lesion debridement Electrodesiccation, 72–3 deformity, 41, 41–2, 66 (see also Decubitus ulcers see Pressure ulcers Electrophysical studies, 208 Deep-vein thrombosis (DVT), 39 Electrosurgery, 72–3 specific deformity) Dehydration, foot veins in, 38–9 Endothelial cells, age-related eversion, prevalence, 2 Dermal melanotic naevocellular naevus, muscles, age-related physiological physiological changes, 16 91 Epidemiology of foot problems, 1–9 changes, 21–2 Dermatitis, 80, 80–1 Epidermal inclusion cysts, 86, 88, 88 physiological changes in the ageing Dermatofibromas, 86, 88 Epidermis, age-related physiological Dermatological assessment, 34, 34–6, see Age-related physiological changes, 14–15 changes 35 Epidermophyton spp. pronation, hallux valgus, 152 Dermatophilus congolensis, 83 Foot posture Dermatophytes, 84, 103 onychomycosis, 103 assessment, 42, 42 Dermis, age-related physiological tinea pedis, 84 effect of age on, 20 Erysipelas, 83 Haglund’s deformity, 201 changes, 14–15 Erythema multiforme, 81 tibialis posterior dysfunction, 198 Diabetes Erythema nodosum, 81 Foot Posture Index (FPI), 42 Erythema pernio, 125, 125–6 Foot problems ankle–brachial index, 38 Ethnicity, risk factors, 7 consequences of, 7–9 foot ulcers see Diabetic ulcers European Wound Management deformity, 41, 41–2, 66 (see also ill-fitting footwear effects, 237 specific deformity) keratotic lesions, 66 Association algorithm, 138 epidemiology of, 1–9 Diabetic ulcers, 129, 130–1, 131 Exfoliative erythroderma, 81 prevalence of, 1–5 guidelines for the management of, Exostectomy, 201 risk factors for, 5–7 Exostoses, subungual, 109, 109 Footwear, 235–46 141 Extended shaft pad, 222 advising about, 244–5, 246 pressure relief, 133–4 Extensor digitorum brevis testing, 45 assessment, 30, 53, 53–5, 54, 55 Diagnostic imaging, 30, 47–8 Extensor digitorum longus testing, 45 balance and falls, 55, 240–4 Achilles tendinopathy, 203–4 Extensor hallucis brevis testing, 45 detrimental effects of, 236–7 tibialis posterior dysfunction, 199 Extensor hallucis longus testing, 45 elevated heels, 237 see also specific technique Extracorporeal shockwave therapy, fixation method, 244 Dietary supplements, 136 foot ulcers, 133–4, 134 Diffuse idiopathic skeletal hyperostosis, 197 habits of older people, 235–6 hallux limitus/rigidus, 162 195 Falls hallux valgus, 151 Digital clubbing see Nail clubbing consequences of foot problems, 8 heel collar height, 243 Distal subungual onychomycosis, 100 and footwear, 55, 240–4 heel height, 241–2 Dorsal bunion see Hallux risk assessment, 51, 53 ill-fitting, 53, 235–6, 236 keratotic lesions, 66–7 limitus/rigidus Fat pad atrophy, 194 inappropriate, 235–6, 236 Dorsal venous arch vein, 39 Fatigue fractures, 186 gender differences, 6 Dorsiflexion night splints, 196 Feet First study, 179 Dorsoplantar prop, 219 Femoral artery bruit, 37, 38 Draw test, 185, 185 Fibromas, 86 Dressings, wound, 132–3 Fibrous corns, 62 Drug-induced eczema, 81 First ray hypermobility, 152

254 Index Haemangiomas, 86, 89, 90 Hammer toes, 165 Haglund’s deformity, 200, 200–2 plantar metatarsal pad, 220 intermetatarsal neuroma, 183 prevalence, 3, 4 lesser toe deformities, 167 aetiology, 200 surgical treatment, 168 midsole cushioning, 241–2 assessment and diagnosis, 201 midsole flaring, 243 clinical presentation, 200–1, 201 Hard corns, 62, 63, 64, 69 modifications, 237–9 definition, 200 Harris & Beath mat, 51 retrocalcaneal pad, 222 Hattrap & Johnson classification, 158, for keratotic lesions, 72 treatment slip resistance of outersoles, 159 conservative, 201 Health Belief Model, 244–5 242–3 surgical, 201–2, 202 Health sandals, 228 specialist, 239–40, 240 Hallux abductus angle, 150, 153, 153 stretching, 239, 240 Hallux equinus, 157 keratosis, 67 Footwear Suitability Scale, 245 Hallux extension, 45, 46 Health-related quality of life, 8–9 Forefoot disorders, 179–87 Hallux flexion, 45, 46 Heel calluses, 70, 70 classification, 179–80 Hallux flexus see Hallux limitus/rigidus Heel collar height, 243 common causes of pain, 181–6 Hallux interphalangeus abductus angle, Heel cups, rigid, 197 definition, 179–80 153, 153, 160 Heel height, 241–2 diagnosis, 180–1 Hallux limitus/rigidus, 41, 52, 157–65 Heel pad, 221, 222, 224 malalignments, 42 aetiology, 158–61, 160 prevalence, 179–80 assessment and diagnosis, 161, age-related physiological changes, see also specific disorder 161–2 16 Forefoot imbalance pads, 221 classification, 158, 159 Forefoot rockers, 238, 238 clinical presentation, 158, 158 shock-absorbing, 197 Fowler–Philip’s angle, 200, 200 footwear assessment, 54 Heel pain see Plantar heel pain Fracture, stress, 48, 181, 186 functional, 158 Freiberg’s infraction, 181–2 keratotic lesions, 66 syndrome; Retrocalcaneal Frontal-related gait disorders, 50 subungual exostosis, 109 conditions Fulguration, keratotic lesions, 72 treatment, 162–5 Heel raises, 238–9, 239 Functional assessment, 30, 49–53 conservative, 162–3 Heloma durum, 62, 63, 64, 69 Functional hallux limitus, 158 surgical, 163–5, 164 Heloma fascia, 62 Functional orthoses, 218, 225–6, Hallux valgus, 149–57, 150, 153 Heloma milliare, 62, 63, 65, 65 aetiology, 150–2 Heloma molle, 62, 63, 64 226 first ray hypermobility, 152 Heloma neurovasculare, 62 Functional reach test, 53 foot pronation, 152 Heloma vasculare, 62 Fungal infections, 83–5 footwear, 151 Helomata see Corns long first metatarsal, 151 Hemiplegia, 50 prevalence, 4 metatarsal head shape, 151–2 Herbal medications, 31 studies, 3 metatarsus primus varus, 151 High arches, 4 see also Tinea pedis muscle dysfunction, 152 High-heeled footwear, 241 assessment, 41, 41, 153, 153 High-Dye taping, 199 Gait analysis classification, 150 Hindfoot orthoses (HFO), 227 ankle–foot orthoses, 227 clinical presentation, 150 Hippocratic nails see Nail clubbing Haglund’s deformity, 201 congenital, 150–1 Horseshoe pad, 218, 219 diagnosis, 153, 153 Howel-Evans syndrome, 68 Gait disorders falls, 8 Hydration status, 38–9 classifying, 49–50 foam sleeves, 220 Hydrocolloid dressings, 133 clinical analysis, 50–1 foot pressure recordings, 52 keratotic lesions, 70 evaluation of, 49–51 footwear assessment, 53, 54, 236 Hydrogels, 132, 133 gender differences, 6 Hydrogen atoms, 48 Ganglion cysts, 86, 88–9, 89 iatrogenic, 152 Hyperbaric oxygen therapy, 135–6 Gangrene, 122, 123 keratotic lesions, 66 Hyperkeratosis, 15 Gastrocnemius testing, 45 prevalence, 2, 3–4, 4, 5 physiological, 63 Gender splints, 224, 224 prevalence, 2 treatment, 153–7 Hypertension, venous, 126–7 effect on prevalence, 4 conservative, 153–4 Hypertrophic osteoarthropathy, 195 risk factors, 6 surgical, 154–7, 155–7 Hyphae, 100 Girdlestone–Taylor procedure, 168 Hallux varus, 169, 169 Goniometer, flexible, 43, 44 Halo naevomelanocytic naevus, 91 Iatrogenic hallux valgus, 152 Gordochom solution, 101 Ichthyosis, 68 Gouty arthritis, 169–70, 170 Immersion foot, 126 Gravitational eczema, 80, 80–1 Implant arthroplasty, 163–4, 164 Griseofulvin Inclusion cysts, 86, 88, 88 onychomycosis, 102 tinea pedis, 85 Guttate psoriasis, 82

Index 255 Income, risk factors, 7 Itraconazole Langerhans cells, age-related Infection onychomycosis, 102 physiological changes, 14 tinea pedis, 85 risk factors, 15 Lapidus procedure, 155–6 skin, 83–5 Joints Larval therapy, 132 wound, 137, 137–9 age-related physiological changes, Lateral plantar nerve entrapment, see also specific infection 18–19 Inflammatory response, age impaired, fusion see Arthrodesis 195 Lazy-L incision, 201–2, 202 14 Junctional melanotic naevocellular Lentigo maligna, 94 Ingrown toenails see Onychocryptosis naevus, 91 Lesion debridement Initial assessment interview, 29–34, Keep Them Walking project, 3 foot ulcers, 132 30 Keller procedure keratotic lesions, 69, 69–70 Injection therapy Lesser toe deformities, 41, 165–8 hallux limitus/rigidus, 163, 164 aetiology, 167 Achilles tendinopathy, 204 hallux valgus, 155, 155 assessment and diagnosis, 167 Haglund’s deformity, 201 Keratan sulphate, 19 classification, 165–7, 166 hallux limitus/rigidus, 162 Keratin, age-related physiological clinical presentation, 165–7 intermetatarsal neuroma, 183 footwear assessment, 236 keratotic lesions, 70–1 changes, 15 keratotic lesions, 66 plantar heel pain syndrome, 196 Keratinocytes, 99 treatment, 167–8 predislocation syndrome, 185–6 Injuries as a consequences of foot age-related physiological changes, conservative, 167 14, 15 surgical, 167–8 problems, 8 see also specific deformity Inpatient settings research studies, 2 onychomycosis, 100 Lesser toe extension/flexion, 46 Insoles Keratoacanthomas, 89, 90 Leukonychia Keratoderma climacterium, 68 medication use-associated, 114, contoured, 224–5, 225 Keratoderma punctata, 68 114 hallux valgus, 154 Keratolysis, pitted, 83, 84 systemic diseases-associated, 111, keratotic lesions, 71, 72 Keratomas see Calluses 113, 113 non-cast, 218, 222–3 Keratosis follicularis, 68 Lichen planus, 82, 82–3 Instrumental activities of daily living Keratotic lesions, 61–74 Lichenoid dermatitis, 81 Ligaments, age-related physiological (IADLs), 49 aetiology, 62–7 changes, 19–20 Integumentary system, 13–16 assessment and diagnosis, 67–9 Limb colour, abnormal, 37, 38 classification, 61–7 Limb ischaemia, critical, 37, 122 dermis, 14–15 clinical presentation, 61–7 Limb length discrepancy, 238–9, 239 epidermis, 14–15 forefoot pain, 181 Liquid silicone injections, 71 functional implications, 15 less common causes of, 67, 68 Livedo reticularis, 124–5, 125 nails, 15 pathogenesis, 62–5, 65 Long arch pad, 221, 222 plantar soft tissues, 15–16 plantar, 41 Low-Dye taping plantar metatarsal pad, 220 plantar heel pain syndrome, 196 functional implications, 16 risk factors, 65–7 tibialis posterior dysfunction, 199 heel pad, 16 treatment, 69–74 Lumbricals testing, 45 metatarsal pads, 15–16 Lunge test, weightbearing, 43, 44 summary of age-related changes, conservative, 69–72 Lunula nail discoloration, 114, 114 14 footwear modification, 72 Lymphoedema, 128, 128–9 Interdigital neuroma, 220 injection therapy, 70–1 Interdigital tinea pedis, 84, 85 lesion debridement, 69, Macrophages, age-related physiological Interdigital wedge, 219, 219–20, 223, 69–70 changes, 14 224 orthotic therapy, 71, 71–2 Intermetatarsal angle, 150, 151, 153, topical treatments, 70, 70 Macule, 35 153 Magnetic resonance imaging (MRI), Intermetatarsal neuroma, 181, 182–4 surgical, 72–4 aetiology, 182, 182 electrosurgery, 72–3 48 clinical presentation, 182 orthopaedic surgery, 73, 73– Achilles tendinopathy, 204 treatment 4, 74 Haglund’s deformity, 201 conservative, 182, 182 intermetatarsal neuroma, 182 surgical, 182–3 see also Calluses; Corns plantar heel pain syndrome, 194 Intermittent claudication, 36–7, 122 Ketanserin ointment, 133 tarsal tunnel syndrome, 208 Interphalangeal joint, proximal, 186 Ketoconazole, 102 tibialis posterior dysfunction, 199 Interstitial spaces tenderness, Kinaesthesia, effect of age on, 18 Mal de Meleda, 68 prevalence, 4 Knee flexion test, 203 Intraosseous lipoma, 195 Koebner phenomenon, 82 Iron, 136 Koilonychia, 111, 113, 113

256 Index Malignant melanoma, 92, 94, 94 Metatarsophalangeal joints strength testing, 44–7, 46 differentiation from subungual fusion of see Hallux limitus/rigidus strengthening, 204 exostoses, 109 instability, 184 (see also Muscular system, age-related Predislocation syndrome) Mallet toes, 165 manual muscle testing, 45 physiological changes, 20–2 prevalence, 4 range of motion, 43, 43–4 Musculoskeletal assessment, 41–7 surgical treatment, 167–8 restricted range of motion see Mycology, 34–5 Hallux limitus/rigidus Myelin sheaths, age-related Manchester Foot Pain and Disability subluxation, 184 (see also Index (MFPDI), 33–4 Predislocation syndrome) physiological changes, 17 tenderness, prevalence, 4 Myopathic conditions, effect on gait, Manchester scale, 41, 41 Manipulation Metatarsus primus elevatus, 160 50 Metatarsus primus varus, 151 Myosin filaments, 20 hallux limitus/rigidus, 162 Miconazole nitrate solution, 101 Myxoid cysts see Mucous (myxoid) hallux valgus, 154 Micrococcus sedentarius, 83 Manual muscle testing, 44–7, 46 Microsporum, 103 cysts Marjolin’s ulcer, 94 Midfoot disorders, 191–209 Mast cells, age-related physiological Naevi, 90, 91 osteoarthritis, 205–7 Nail avulsion changes, 14 see also specific disorder Matrixectomy, 103 Midsole cushioning, 241–2 onychocryptosis, 105, 106, 106–7, Mecca foot, 67 Midsole flaring, 243 107 Medial calcaneal nerve entrapment, Milroy’s disease, 128 Mini-Mental State Examination onychogryphosis and onychauxis, 194, 195 108–9 Medial malleolus tenderness, (MMSE), 31 Mitchell osteotomy, 156, 156 onychomycosis, 103 prevalence, 4 Mobilisation Nail bracing, 104–5, 105 Medial plantar nerve entrapment, Nail clubbing, 109–10, 110 hallux limitus/rigidus, 162 195 hallux valgus, 154 systemic diseases-associated, 111, Medical grade footwear, 239–40, 240 Mobility 113, 113 Medical history, 29–31 consequences of foot problems, Medication use Nail disorders, 99–115 7–8 associated with systemic diseases Achilles tendinopathy, 203 objective measures of, 49 and medications, 111–12, initial assessment interview, 31 Moccasin foot, 84 113–14 nail disorders associated with, Moles, 90, 91 elongated, 4 Mönckeberg’s sclerosis, 38 ingrown see Onychocryptosis 111–12 Monoarticular non-traumatic synovitis, prevalence, 2, 4, 5 onychocryptosis risk, 104 thickened see Onychauxis; skin eruptions associated with, 81 184 Onychogryphosis Meissner corpuscles, age-related see also Predislocation syndrome see also specific disorder Morbilliform drug eruptions, 81 physiological changes, 17 Morton’s extension, 222 Nails, age-related physiological Melanoma, malignant, 92, 94, 94, Morton’s foot type, 222 changes, 15 Morton’s metatarsalgia see 109 National Health Interview Survey Merkel discs, age-related physiological Intermetatarsal neuroma (NHIS), 4 Morton’s neuroma see Intermetatarsal changes, 17 Navicular Metallic implants, 164 neuroma height, 42 Metatarsal dome, 183, 220–1, 221, Mosaic verrucae, 86, 87 radiographs, 47 Moulds, 101 224 Mucous (myxoid) cysts, 89–90, 90 Nerve entrapment, heel pain, 194, Metatarsal formula, 41 195 Metatarsal head calluses, 62, 62, 63 incidence, 86 Metatarsal pad, 183, 220–1, 221, 224 Mulder’s click test, 180, 182, 182 Neuritic symptoms, forefoot pain, Muscle mass reduction, 20–1 180 age-related physiological changes, Muscle tissue, age-related physiological 15–16 Neurological assessment, 39–41 changes, 20–1 Neuropathic conditions, effect on gait, Metatarsal shaft pad, 221, 221–2 Muscle(s) Metatarsalgia, 179–80 50 ankle, 21, 45, 46 Neuropathic heel pain, 194 common causes, 181–6 dysfunction, hallux valgus, 152 Neurovascular corns, 62 diagnosis, 180–1 foot, 21–2 Night cramps, 37, 122 Metatarsals strength reduction, 21 Nikolsky’s sign, 81 head shape, 151–2 Nocturnal cramps, 37, 122 insufficiency stress fracture, 48, 181, Nodular basal cell carcinoma, 93 Nodular malignant melanoma, 94 186 Nodule, 35 length of, 41–2 Non-cast insoles, 218, 222–3 long first, 151 radiographs, 47

Index 257 Non-steroidal anti-inflammatory drugs Oral treatments for onychomycosis, Weil, 73, 73 (NSAIDs) 102–3 Wilson, 156, 156 Ostler’s toe see Onychogryphosis gout, 170 Ordinary psoriasis, 81–2, 82 Outpatient settings research studies, osteoarthritis, 206 Orthonyxia, 104–5, 105 plantar heel pain syndrome, 196 Orthopaedic surgery, keratotic lesions, 2–3 Non-weightbearing radiographs, 47 Over-riding toe, 165–6, 166 73, 73–4, 74 Obesity Orthotic therapy, 217–29 surgical treatment, 168 Achilles tendinopathy, 203 calluses, 66 Achilles tendinopathy, 204 Pacinian corpuscles, age-related plantar heel pain syndrome, 193 as a balance aid, 228–9 physiological changes, 17 risk factors, 6 basic principles, 217 classification and nomenclature, Paget’s disease, 194 Oligosaccharides, 19 Pain Omega nails, 111, 111, 112 217–18 Onychauxis, 15, 99, 107–9, 108 cost of, 217 assessment, 32, 32–4, 40 foot ulcers, 133–4, 134 first step, 192 aetiology, 107–8 hallux limitus/rigidus, 162–3 footwear assessment, 53 clinical presentation, 107–8 hallux valgus, 154 forefoot see Metatarsalgia treatment, 108–9 intermetatarsal neuroma, 183 gender differences, 6 Onychocryptosis, 99, 103–7, 103–7 keratotic lesions, 71, 71–2 heel see Plantar heel pain syndrome; aetiology, 103–4 and knee osteoarthritis, 227–8 assessment, 104 osteoarthritis, 206–7 Retrocalcaneal conditions diagnosis, 104 plantar heel pain syndrome, 196–7 Manchester Foot Pain and Disability interdigital wedge, 219–20 predislocation syndrome, 185–6 pincer nails, 111 tibialis posterior dysfunction, Index, 33–4 prevalence, 4 peripheral arterial disease, 37 risk factors, 103–4 199 prevalence, 2, 3, 4 treatment see also specific orthoses Palmoplantar keratoderma, 67, 67, Osteoarthritis, foot, 205 conservative, 104–5 ankle–foot orthoses, 227 68 surgical, 105–7 clinical presentation, 206, 206 Palmoplantar keratosis, 68 Onychogryphosis, 99, 107–9, 108 effect of age on, 20 Paper grip test, 44, 47 aetiology, 107–8 prevalence, 205 Papule, 35 clinical presentation, 107–8 risk factors, 205 Papulosquamous diseases, 81–3, 82 treatment, 108–9 treatment Parallel strip padding, 221 Onycholysis Paraplegia, 50 medication use-associated, 112, conservative, 206–7 Paresis, 50 114, 114 surgical, 207 Parkinsonism, 49, 50 systemic diseases-associated, 111, Osteoarthritis, knee, 227–8 Paronychia, 104 113, 113 Osteoblasts, age-related physiological yellow nail syndrome, 110 changes, 18 medication use-associated, 114, Onychoma, 86, 88 Osteochondroma, 109 114 Onychomycosis, 15, 99, 100, 100–3, Osteoclasts, age-related physiological 101 changes, 18 onychauxis, 107 aetiology, 100–1 Osteoid lipoma, 195 pincer nails, 111 assessment and diagnosis, 101 Osteophytes systemic diseases-associated, 112, classification, 100–1 hallux limitus/rigidus, 162 clinical presentation, 100–1 osteoarthritis, 206 113, 113 interdigital tinea pedis, 84, 85 pincer nails, 111 Pedal pulses, abnormal, 37, 38 mycology, 34–5 Osteoporosis, effect of age on, 20 Pedigree chart, 30, 30 prevalence, 3 Osteotomy Pedorthics, 237–9 recurrence prevention, 103 basal, 156–7, 157 Pentoxifylline, 136 treatment Bonney-Kessel, 163, 164 Peptostreptococcus, 83 oral, 102–3 calcaneal see Calcaneal osteotomy Peripheral arterial disease (PAD), 36–8, surgical, 103 closing wedge, 156, 157 topical, 101–2 crescentic, 156, 157 121–3, 122, 123 types of, 100 keratotic lesions, 73, 73–4, 74 Peripheral motor impairments, 49, 50 Onychophosis, 104 lesser metatarsal, 186 Peripheral sensory system onychauxis, 107 Mitchell, 156, 156 pincer nails, 111 scarf, 155, 155 age-related physiological changes, Schwartz, 73–4, 74 17–18 Watermann, 163, 164 assessment, 39–41 impairments, 49, 50 Peripheral vascular disorders, 121–9 arterial disorders, 121–6 chronic venous insufficiency, 126–8 lymphoedema, 128–9 see also specific disorder

258 Index Peripheral vascular system clinical presentation, 191–2 Pressure ulcers, 129, 130, 131, 132 age-related physiological changes, plantar calcaneal pad, 222 guidelines for the management of, 16–17 treatment, 194–7 142 assessment, 36–9 pressure relief, 133–4 conservative, 194–7 Peripheral venous system assessment, surgical, 197 Prevalence of foot problems, 1–5 38–9 Plantar keratotic lesions, 41 Proprioception, 40 Plantar metatarsal pad, 15–16, 183, Pernio syndrome, 125, 125–6 220–1, 221, 224 effect of age on, 18 Perniosis, 125, 125–6 Plantar padding, 183, 183 Proteoglycans, age-related physiological Peroneal artery calcification, 38 Plantar plate rupture, 184 Peroneus brevis testing, 45 see also Predislocation syndrome changes, 19 Peroneus longus testing, 45 Plantar pressure patterns, 51, 52 Proximal subungual onychomycosis, Perthes manoeuvre, 38 calluses, 65 Pes cavus, 207 hallux limitus/rigidus, 158, 158 100 hallux valgus, 153, 153 Pseudogout, 170 foot pressure recordings, 52, 207, intermetatarsal neuroma, 183 Psoriasis, 81–2, 82, 112, 112 207 keratotic lesions, 71 Psoriasis vulgaris see Chronic plaque lesser toe deformities, 167 footwear assessment, 54 pes cavus, 207 psoriasis painful, 207, 207–8 tibialis posterior dysfunction, 198, Psoriatic arthritis, 195 Pes planus see Flat feet 198 Pulse transmission times, 17 Phalanges, 47 Plantar skin, age-related physiological Pump bumps see Haglund’s deformity Phenolisation, onychocryptosis, 105, changes, 14–15 Pustular psoriasis, 82, 82 Plantar soft tissues, 15–16 Pustule, 35 106–7, 107 age-related physiological changes, Physiological hyperkeratosis, 63 15–16 Quadriceps muscles, age-related Piezogenic pedal papules, 90, 91 functional implications, 16 physiological changes, 21 Pigmented basal cell carcinoma, heel pads, 16 metatarsal pads, 15–16 Radiography, plain film see Plain film 93 Plantar warts, 67, 86, 87 radiography Pigmented nail bands, medication use- Plaque, 35 Podagra, 170 Ram’s horn nail see Onychogryphosis associated, 114, 114 Pole test, 38 Range of motion assessment, 43, Pincer nails, 111, 111, 112 Porphyromonas, 83 Piroxicam, 204 Position sense, 40, 41 43–4 Pitted keratolysis, 83, 84 Posterior heel pad, 222 Raynaud’s phenomenon, 123–4, Pitted nails, 112, 112, 113, 113 Posterior tibial nerve, 208 Plain film radiography, 47–8 Potassium hydroxide, 101 124 Predislocation syndrome, 181, 184, conditions associated with, 124 Achilles tendinopathy, 203 184–6 diagnostic criteria, 124 osteoarthritis, 206, 206 aetiology, 184–5 Rearfoot disorders, 191–209 plantar heel pain syndrome, 193 clinical presentation, 184–5 malalignments, 42 tibialis posterior dysfunction, plantar metatarsal pad, 220 osteoarthritis, 205–7 treatment, 185–6 see also specific disorder 199 conservative, 185, 185–6 Rearfoot rockers, 238, 238 Plantar calcaneal pad see Heel pad surgical, 186 Regnauld classification, 158, 159 Plantar cover/pad, 220, 221 Prefabricated orthoses, 218, 223–5, Research studies Plantar digital neuroma see 225 in aged care facilities and inpatient contoured insoles, 224–5, 225 Intermetatarsal neuroma hallux valgus splints, 224, 224 settings, 2 Plantar facilitation, 228 silicone and viscoelastic devices, community-based, 3–5 Plantar fascia 223–4, 224 Presenting complaint, 30, 32–4 UK, 4–5 age-related physiological changes, key questions, 32 USA, 3–4 20 location and history of, 32 in outpatient settings, 2–3 pain assessment, 32, 32–4 Rest pain, 37, 122 plantar heel pain syndrome, 192 Pressure perception, 40 Retracted toes, 165, 166, 168 rupture, 194 Pressure relief, ulcers, 133–4, 134 Retrocalcaneal bursitis see Haglund’s tenderness, prevalence, 4 deformity Plantar fasciitis, 191, 192, 194 Retrocalcaneal conditions, 199–204 see also Plantar heel pain syndrome Retrocalcaneal pad, 222 Plantar heel pad tenderness, prevalence, Rheumatoid arthritis heel pain, 195 4 keratotic lesions, 66 Plantar heel pain syndrome, 191–7 Rigid hindfoot orthoses (HFO-R), 227 aetiology Risk factors for foot problems, 5–7 pathogenesis, 192 risk factors, 192–3 assessment and diagnosis, 193–4 classification, 191–2, 192

Index 259 Rocker-soled footwear, 238, 238 Skin, dry Surgical treatment hallux limitus/rigidus, 162 assessment of, 34 Achilles tendinopathy, 204 prevalence, 2, 3–4, 4, 79 chronic venous insufficiency, 127 Saddle pad, 219, 220 debridement, 132 Salicylic acid Skin lesions, 85–95 hallux limitus/rigidus, 163–5, 164 assessment, 34, 34–6 hallux valgus, 154–7, 155–7 keratotic lesions, 70 benign, 86–91 intermetatarsal neuroma, 183–4 verrucae, 86 incidence, 86 keratotic lesions, 72–4 Saline injections, 71 premalignant and malignant, 92–4 lesser toe deformities, 167–8 Sarcopenia, 20–1 prevalence, 79 lymphoedema, 129 Scale, skin, 35 terminology, 35 onychocryptosis, 105–7, 106, 107 Scaphoid pad, 221, 222 see also specific lesion onychomycosis, 103 Scarf osteotomy, 155, 155 peripheral arterial disease, 122–3 Schwartz osteotomy, 73–4, 74 Skin tags, 86, 88 plantar heel pain syndrome, 197 Sclerosing agents injection, 183 Slip resistance of footwear outersoles, predislocation syndrome, 186 Sclerotherapy, 127, 128 tibialis posterior dysfunction, 199 Sealed surface wound suction, 135 242–3 Seed corns, 62, 63, 65, 65 Social history, 29–31 Syme’s procedure, terminal, 106, 107 Self-management, 52–3 Sodium hyaluronate, 162 Synovectomy, 199 Semi-permeable film dressings, Soft corns, 62, 63, 64 Synovial cysts see Mucous (myxoid) Soft tissues, plantar see Plantar soft 133 cysts Senile haemangiomas, 86, 89, 90 tissues Synovial fluid, age-related physiological Senile keratosis, 68, 92, 92 Solar dermatoses, 68, 92, 92 Sensory ataxia, 50 Sole raises, 238–9, 239 changes, 19 Sensory neurons, age-related Soleus testing, 45 Systemic diseases Spasticity, 49, 50 physiological changes, 17–18 Spider veins, 127, 127 causing heel pain, 195 Septicaemia, 83 Splinter haemorrhages forefoot pain, 180–1 Sesamoiditis, 181–2 nail disorders associated with, 111– Sex see Gender medication use-associated, 114, Sham therapy 114 12, 113 secondary hallux valgus, 152 foot ulcers, 136 systemic diseases-associated, 111, Systems examination, 30, 34–47 plantar heel pain syndrome, 113, 113 Tactile sensitivity, 40 196 Splinting Tailor’s bunion, 4, 168, 168–9 S-heel, 237–8, 238 hallux valgus, 224, 224 Talus insufficiency fracture, 48 Shock-absorbing cushioned heels plantar heel pain syndrome, 196 Taping techniques predislocation syndrome, 185 (SACHs), 237, 238 plantar heel pain syndrome, 196–7 Shoe stretching, 239, 240 Squamous cell carcinoma, 92, 94, 94 predislocation syndrome, 185, Shoes see Footwear differentiation from subungual Short-wave diathermy, 136 exostoses, 109 185 Silicone appliances, 223–4, 224 incidence, 86 tibialis posterior dysfunction, 199 Silicone implants, 164 Tarsal tunnel syndrome, 208 Silicone injections, liquid, 71 Squamous cell carcinoma in situ see Tea tree oil, 101 Silicone orthodigita, 222, 223 Bowen’s disease Teardrop pads, 221 Silver’s bunionectomy, 154–5 Telangiectasia, 127, 127 Sinus tarsi syndrome, 208 Staphylococcus aureus, 83 Temperature perception, 40 Sit-to-stand test, 49 Stasis dermatitis, 80, 80–1 Tendon pad, 219, 220 Skeletal system, age-related Statins, 203 Tendons, age-related physiological Stock footwear, 239–40, 240 physiological changes, 18–20 Strength testing, muscle see Muscle(s), changes, 19–20 Skin Terbinafine strength testing age-related physiological changes, Streptococcus pyogenes, 83 onychomycosis, 101–2 14–15 Stress fracture tinea pedis, 85 Terminal Syme’s procedure, 106, 107 assessment, 34, 34–6, 35 calcaneal, 194 Thomas heel, 237–8, 238 cool, 37, 38 metatarsals, 48, 181, 186 Thomas wedge, 238 disorders, 79–94 (see also specific Stucco keratoses, 90–1, 91 Thompson test, 203 Subatmospheric pressure therapy, Thrombosis, 123 disorder) Tibial artery, absent pulse, 2 prevalence, 2, 4 135 Tibialis anterior grafting, foot ulcers, 136–7 Subungual exostosis, 109, 109 hallux valgus, 152 infections, 83–5 (see also specific Subungual heloma, 62, 64 testing, 45 infection) Superficial basal cell carcinoma, 93, 94 Superficial spreading malignant melanoma, 94, 94

260 Index Tibialis posterior dysfunction, 52, 197, Two-point discrimination, 40 Vasospastic disorders, 123–6 197–9 Tylomas see Calluses Veins, age-related physiological aetiology, 198 Ulcerative tinea pedis, 84 changes, 17 ankle–foot orthoses, 227 Ulcer(s), 129–39 Venous hypertension, 126–7 assessment and diagnosis, 198–9 Venous insufficiency, chronic, 126–8, classification, 197–8 characteristics, 130 clinical presentation, 197, 197–8 chronic venous insufficiency, 126 127 plantar pressure, 198, 198 clinical presentation, 129–31 clinical presentation, 126–7 treatment, 199 definition, 35 epidemiology, 126 Tibialis posterior testing, 45 epidemiology, 129 pathophysiology, 126–7 Timed up and go test, 53 peripheral arterial disease, 122, risk factors, 126 Tinea pedis, 83–5, 85 treatment, 127–8 prevalence, 3, 79 122 Venous stasis eczema, 80, 80–1 Toe covers, 224 wound management, 131–9 Venous system assessment, peripheral, Toe deformities lesser see Lesser toe deformities cleansing, 132 38–9 missing, 4 compression therapy, 134–5 Venous ulcers, 130, 130 overlapping, 4 debridement, 132 prevalence, 2 dietary supplements, 136 compression therapy, 134–5 see also specific deformity dressing, 132–3 dressings, 133 Toe prop, 219, 219, 223 guidelines for the management of, Toe separator, 154 evidence-based guidelines for Toe sleeve, 219 comprehensive, 139 140 Toe spacers, 104, 104 Verrucae, 67, 86, 87 Toenail problems see Nail disorders hyperbaric oxygen therapy, Vesicle, 35 Toe(s) 135–6 Vesicular tinea pedis, 84 amputation see Amputation, toe Vestibular ataxia, 50 disorders, 149–70 (see also specific infection, 137–9 Vibration sense, 40, 41 pentoxifylline, 136 Viscoelastic devices, 223–4, 224 disorder) pressure relief, 133–4, 134 Visual ataxia, 50 plantarflexor strength, 44 short-wave diathermy, 136 Vitamin A, 136 Tolnaftate, 85 skin grafting, 136–7 Vitamin C, 136 ‘Too many toes’ sign, 199 therapeutic ultrasound, 136 Vitamins, 136 Tophi, 170, 170 topical negative pressure, 135 Vulnopur, 132 Topical negative pressure (TNP), Ultrasonography, 48 Achilles tendinopathy, 203–4 Wagner classification, 35–6 135 forefoot pain, 180 Walking speed, 49, 51, 53 Topical treatment Haglund’s deformity, 201 Warts, 67, 86, 87 intermetatarsal neuroma, 182 Watermann osteotomy, 163, 164 foot ulcers, 136 plantar heel pain syndrome, 193–4 Weal, 35 keratotic lesions, 70, 70 therapeutic, 136 Weightbearing lunge test, 43, 44 onychomycosis, 101–2 tibialis posterior dysfunction, 199 Weightbearing radiographs, 47 plantar heel pain syndrome, 196 Undecenoic acid, 85 Total dystrophic onychomycosis, Under pad, 221, 221–2 Haglund’s deformity, 201 Under-riding toe, 166, 166 hallux limitus/rigidus, 161, 161–2 100–1, 101 Unguis incarnates see Onychocryptosis Weil osteotomy, 73, 73 Trabecular bone, age-related Unipedal stance, 53 White superficial onychomycosis, 100 University of Texas classification, Wilson osteotomy, 156, 156 physiological changes, 18 36 Winograd procedure, 105–6, 106 Trace elements, 136 U-pad, 218–19, 219 Winter heel see Haglund’s deformity Transfer lesions, 66, 73 Urea cream, 101 Wound management, 131–9 Treadmills, 51 Urticarial drug reactions, 81 cleansing, 132 Treatment outcomes assessment, compression therapy, 134–5 Vacuum assisted wound closure, 135 debridement, 132 55–6 Vacuum sealing technique, 135 dietary supplements, 136 Trench foot, 126, 126 Valgus pad, 221, 222 dressing, 132–3 Triceps strengthening, 204 Varicose eczema, 80, 80–1 evidence-based guidelines for Trichophyton spp., 103 Varicose veins, 126, 127, 127 Vascular assessment, 36–9 comprehensive, 139 onychomycosis, 100, 103 Vascular corns, 62 hyperbaric oxygen therapy, 135–6 tinea pedis, 84 Vascular system, peripheral see infection, 137–9 Trumpet nails, 111, 111, 112 pentoxifylline, 136 Tulle dressings, 133 Peripheral vascular system pressure relief, 133–4, 134 Tumours, 85–94 Vasoconstriction, 125 short-wave diathermy, 136 see also specific tumour

skin grafting, 136–7 healing, 15 Index 261 therapeutic ultrasound, 136 severity, 35–6 topical negative pressure, 135 Xenografts, 137 YakTrax® Walker, 242–3, 243 Wound(s) Xerosis scale, 34, 35 Yellow nail syndrome, 110, 110 assessment, 35, 36 Xerotic eczema, 80, 80 Youngswick procedure, 163, 164 biopsy, 138 X-ray see Plain film radiography Zadik technique, 106, 106 Zinc, 136