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CORNS AND CALLUSES

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Calluses represent a dermatologic reaction to focal pressure. They are protective and should not be treated unless they are painful. Ongoing pressure may cause calluses to develop into corns. Corns have a central hyperkaratotic core that is often painful. Hard corns can resemble warts, but can be differentiated with incision; warts will bleed, corns will not. The differential diagnosis includes syphilis, psoriasis, lichen planus, rosacea, arsenic poisoning, basal cell nevus syndrome, and malignancy. Treatment for corns often includes paring with a scalpel to include removal of central keratin plug, but topical salicylic acid treatments may be more effective.

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PLANTAR WARTS

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Plantar warts are common, contagious, and caused by the human papillomavirus. The diagnosis is clinical and the differential includes corns and undiagnosed melanoma. Topical treatment with 15% to 20% salicylic acid is most effective. Nonhealing lesions should be referred to a dermatologist or podiatrist.

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ONYCHOCRYPTOSIS (INGROWN TOENAIL)

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Onychocryptosis is characterized by increased inflammation or infection of the lateral or medial aspects of the toenail. This occurs when the nail plate penetrates the nail sulcus and subcutaneous tissue (usually in the great toe). Patients with underlying diabetes, arterial insufficiency, cellulitis, ulceration, or necrosis are at risk for amputation if treatment is delayed. Treatment depends on the type of inflammation. If the toenail is uninfected, sufficient results will often be obtained with elevation of the nail with a wisp of cotton between the nail plate and the skin, daily foot soaks, and avoidance of pressure on the area. A second option (requiring digital block) is to remove a spicule of the nail and debride the nail groove (Fig. 183-1). If granulation tissue or infection is present, partial removal of the nail is indicated. If the toenail is infected, perform digital block and cut one-fourth or less of the nail, including beneath the cuticle, with a longitudinal incision (Fig. 183-2). A nonadherent bulky dressing should be placed and the wound should be checked in 24 to 48 hours.

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Figure 183-1

Partial toenail removal. This method is used for small nail fold swellings without infection. After antiseptic skin preparation and digital nerve block, an oblique portion of the affected nail is trimmed about one-third to two-thirds of the way back to the posterior nail fold. Use scissors to cut the nail; use forceps to grasp and remove the nail fragment.

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Figure 183-2

Partial toenail removal (infection present). This method is used for onychocryptosis in the setting of significant granulation tissue or infection.

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BURSITIS

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Calcaneal bursitis causes pain over the posterior heel in contrast to Achilles tendinopathy that causes pain and tenderness 2 to 6 cm superior to the posterior ...

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