By R. P. R. Dawber, Ivan Bristlow, Jean Mooney

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Extra resources for The Foot: Problems in Podiatry and Dermatology

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Coli infections 37 Figure 35 Vascular inflammation and necrosis due to systemic sclerosis. Figure 36 Splinter haemorrhages under the nail. g. g. g. g. g. osteoarthritis) loss of articular space, osteophyte formation, sclerosis, cystic degeneration, limitation of movement and eventual ankylosis of the joint It is usually painful on movement, but may cease when the affected joint has become ankylosed Ulceration The various types of ulcer seen in the foot are given in Table 16, and the typical sites of occurrence are shown in Figure 37.

Inflammation in tendons The synovial sheaths of the extrinsic tendons may undergo a process of inflammation—tendonitis—as a result of chronic overuse or sudden twisting trauma, or in rheumatoid diseases. The problems that can arise are illustrated in Figure 31. g. g. g. g. g. acute hallux limitus, hallux valgus. Characteristics and symptoms of inflammatory joint diseases are shown in Tables 14 and 15 and Figure 32. g. rheumatoid arthritis; juvenile chronic arthritis (Still’s disease); CREST diseases Characteristic pattern of joint deterioration, over a period of years: – initial swelling and proliferation of the synovial lining of the joint erosion of joint surfaces – cystic degeneration of bone – presence of rheumatoid factor in blood Affected joints: – initially hot, red, swollen and tender – movement hampered by pain and stiffness, especially in the morning – 5 MTPJ is often the first foot joint affected.

Terbinafine is fungicidal at routine therapeutic concentrations and reaches adequate tissue levels in the most distal nail bed and nail plate within 3–4 weeks of the first dose. The early studies showed mycological cure rates of greater than 90% following only twelve weeks’ treatment—dose 250 mg daily; subsequently similar cure rates have been produced with 6 weeks’ therapy—compared with fungistatic oral griseofulvin which gives less than 50% success rates even if continuous treatment is given for over 1 year.

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