Diagnosis of Athlete's foot
Athlete's foot Diagnosis: Book Excerpts
Diagnostic Tests for Athlete's foot: Online Medical Books
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FOOT AND TOE PAIN:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there fever or localized erythema? Localized erythema would suggest phlebitis, gout, osteomyelitis, cellulitis, ingrown toenail, and paronychia. The presence of fever would make one suspect osteomyelitis and cellulitis.
- Is there associated deformity of the foot? Hallux valgus, hammertoe, hallux rigidus, arthritis, and displaced fracture are the main causes of a deformity of the foot.
- Are the peripheral pulses palpable? Diminished arterial pulses would make one think of arterial embolism, peripheral arteriosclerosis, and diabetes.
- Are there associated neurologic findings? The presence of loss of sensation to touch and pain should make one think of peripheral neuropathy and tarsal tunnel syndrome. Numbness or loss of sensation in the 3rd and 4th toes is often associated with a Morton's neuroma.
DIAGNOSTIC WORKUP
Routine diagnostic tests include a CBC, sedimentation rate, chemistry panel, VDRL test, and an x-ray of the foot. If the peripheral pulses are diminished, Doppler studies and angiography should be considered. If there is diffuse swelling and erythema, venography may need to be done. If there are neurologic findings, nerve conduction velocity studies and electromyograms (EMGs) may be helpful. Consider bone scans, CT scans, and arthroscopy if the above tests are negative. An MRI may be needed to diagnose stress fractures. Abnormal weight distribution is diagnosed by quantitative scintigraphs. It is wise to refer the patient to an orthopedic surgeon or podiatrist before ordering expensive diagnostic tests.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Toe Pain/Swelling:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Gout
–Monosodium urate crystal deposition occurs secondary to hyperuricemia
–Severe pain, redness, and swelling occurring in one joint (80% of cases), usually of the lower extremity, and most classically at the metatarsophalangeal joint of the great toe (podagra)
–Tophi: Collections of solid urate in
connective tissue
-
Ingrown toenail
–Causes severe pain in the distal nail folds with associated erythema, edema, and tenderness
Trauma
–Contusion
–Fracture
Pseudogout
–Calcium pyrophosphate deposition disease
–Can affect the toe, but the knee is most
common
- Seronegative spondyloarthropathy
–Psoriatic arthritis: Spondyloarthropathy involving middle-aged patients at multiple joints associated with classic skin lesions
–Reiter's syndrome: Arthritis, uveitis, urethritis
- Septic arthritis
–Fever, joint redness, pain with passive and active range of motion
–Most often due to skin flora such as Staphylococcus aureus and various streptococci
–Neisseria gonorrhoeae in young sexually active adults
–Often associated with previous penetrating trauma to the toe
- Less common etiologies (“zebras”) include cholesterol emboli, infective endocarditis, Lyme disease (presents as monoarticular arthritis in 10% of cases), and paronychia (bacterial infection of the posterior nail folds)
Workup and Diagnosis
-
History and physical examination
-
Initial laboratory studies may include CBC, electrolytes,
BUN/creatinine, calcium, magnesium, phosphorus, ESR
–Blood cultures and Lyme titers may be indicated
–Iron studies (ferritin, iron, TIBC) may be useful if suspect
pseudogout, as many patients have underlying hemochromatosis)
- Aspiration of the affected joint and synovial fluid analysis
–Look for infection, inflammation, blood (hemarthrosis of
trauma), and crystals
–Gram stain, culture, and polarized light microscopy
–Fluid cell counts typically reveal <50,000 white blood
cells/mL in inflammatory processes, and >50,000 white
blood cells in infectious arthritis
–Gout: Needle-shaped, negatively birefringent crystals
–Pseudogout: Linear-shaped weakly positively birefringent
crystals
- Radiographs may reveal fractures, chondrocalcinosis (pseudogout), signs of osteomyelitis (septic arthritis), or erosive distal bone changes (psoriatic arthritis)
>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
FOOT, HEEL, AND TOE PAIN:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Special considerations in the approach to the diagnosis of foot pain include examining the shoes for abnormal areas of wear and tear, measuring the arches, palpating the joints for maximal tenderness, and ordering laboratory tests for joint disease (page 341). Nerve blocks and lidocaine injections in the plantar fascia and other areas of maximum tenderness will assist in diagnosis. Abnormal weight distribution is diagnosed by quantitative scintigraphs. A therapeutic trial of proper-fitting shoes and arches may be indicated. Weight control is essential in the obese. Referral to a podiatrist or orthopedic surgeon is often necessary.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
FOOT, HEEL, AND TOE PAIN:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Special considerations in the approach to the diagnosis of foot pain
include examining the shoes for abnormal areas of wear and tear, measuring
the arches, palpating the joints for maximal tenderness, and ordering
laboratory tests for joint disease (page 286). Nerve blocks and lidocaine injections in the plantar fascia and
other areas of maximum tenderness will assist in diagnosis. Abnormal weight
distribution is diagnosed by quantitative scintigraphs. A therapeutic trial
of proper-fitting shoes and arches may be indicated. Weight control is
essential in the obese. Referral to a podiatrist or orthopedic surgeon is
often necessary.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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