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The podiatry, compilation and why is not the same theory to practice after the course

Today I wanted to make a compilation of cases, an individual could not present because of the time would require. I would like to make this compilation an overview, criticism and humility.

things in medicine are not always what they seem, make mistakes is part of learning, as in the photo shown, to the facts most unusual as snow at sea level can occur, for it is rare.

Many times we get to query patients with clinical symptoms of lumbar level, knee, or foot, and after a biomechanical examination, just to diagnose an ankle equinus, gastrocnemius either equine gastrosoleo horses, equine ankle bone block or capsuloligamentous. In women is more common due to lack of stretching, the use of high heels, to have a shorter Achilles tendon than men and that, combined with inactivity, systemic diseases like cholesterol, there is a muscle atrophy, loss of elasticity and systematic contractures over the years.

Unlike the case of this picture, the horse is absolute, do not get to play with the heel on the floor at any time, always walking on tiptoe on one foot, and the other almost touching the heel but also not get it. The years have led to what you have now is a bone block which gets no more than 5 of total joint movement.

This is an interesting case in which I missed in diagnosis. Had been diagnosed with Dyshidrotic eczema (did not have before the HQT) has been treated in accordance to it but was not improved. Was complicated by an infection, the culture was positive for Staphylococcus aureus and Gemella. Luckily for him, in the antibiogram out sensitive to all drugs, although referral to a dermatologist, have given amoxi-clav, when I was using amoxicillin and cloxacillin would change (long live the wise use of antibacterials).

been referred to a dermatologist for psoriatic pustular suspect, since in that case will be with PUVA treatment.
This is the finger of a lady who dropped an object on top, after 3 days, since the day after the injury came ER and prescribed ibuprofen.

is true, that when he went to the emergency, no hematoma was present as exaggerated as the treatment has been correct. When she went because the pain would not let him or walk or sleep, I did a drain and the pain improved significantly. After making a debridement of the area which hurt him, it showed a dislocation of the nail plate in the peroneal canal.

In this case, a recent arrival, after 5 months of healing in the medical center, and ordered him to continue performing the dry cures at home. , Presented with pain.
The patient is not diabetic, but had been operated for years claw toes and metatarsals are not HQT and helomas causing movement in the area, which together with xeroderma eventually cause ulceration.
Without a discharge, the ulcer is impossible to close.

In only 3-4 weeks, the appearance of the ulcer has improved greatly.
now is what is costing close to everything and that you have a plantar orthosis that takes 10 days to download them and not enough and that closes false ulcer covering the area of \u200b\u200bHQT. As I said before, the treatment involves downloading the area, if the plant does not discharge brace enough or it will be tweaked again.
This patient has pain in the hallux for 10 years. By removing the nail plate considerable relief to abolish symptoms. This is what I found. I have asked for a Rx for differential diagnosis between subungual exostosis, vascular tumor or just a wound. The Rx
no noticeable exostosis, and protection of the area, the wound has sent so it was a long-standing injury resulting from repetitive microtrauma caused by the blow of the hallux against the shoe. The patient does not have a hallux pronation hiperextensus but the ASA supine on 1 radio.

This is the sample fibrokeratoma the first patient I operated. I had years with him in the back of the nail plate of 5 th finger, giving now, we deformed the nail plate causing a longitudinal depression. Was removed and 9 months later still has not come out again.
This patient had this injury, but was not the reason for consultation. This was in my early days when dermatology was a big gap for me. Can be categorized as nummular eczema and the onset is due by the patient's underlying disease and its treatments.
This is a case in which the patient had 3 months with a podiatrist and a doctor to treat the helomas it had in the back of the finger. The problem is that they had not done a thorough debridement, and it was closed in vain, and after we debride debrided and the bone, the final cure was at 2 weeks after debridement everything.
See the medial aspect of the distal phalanx of 5 th finger. That helomas is both painful and in some cases, even removing it still bothering you, or returns to bother a few days.
We often blame ourselves that we remove evil, is what it is ignorance, but the blame should be aware that it is theirs. Years of evolution, helomas chronic abuse based on corn remedies and natural remedies to remove infections with non-sterile equipment, etc.

Patient young football player. Not only has a temporary bone, the trine, but has suffered the avulsion fracture. This Rx is made one year after the trauma of a kick. A maximum plantarflexion still bothering him.


View this exposure or until additional tests can be simple, but nothing is further from reality, often come with chronic pain patients for many years of evolution have gone through all the specialists, I have done everything and still not being diagnosed or cured.
In such cases come to us with all faith in the world to see what we can tell.
These cases are more complicated, but the ones I like, look for a diagnosis of any cause in which various causes often coexist.
not easy when diagnosing a disease and everything that we have been taught to treat anything that does not improve the picture.

When we have doubts and we lost, it is helpful to make a differential diagnosis in which we pointed the signs, symptoms, history and other important information. Will also aim symptoms varying over time and how it evolves with different treatments. Then we do several categories. Neuropathic pain, inflammatory pain, mechanical pain. Effect of soft tissue, nerves, vascular, bone, systemic.
The problem is that in more than one occasion we have to label the box in several tables eg: a clinical case update:

elderly patient with tingling in the 1 st finger, also pain on lateral side of the leg to below the peroneal malleolus, it crackles foot in all the movements without knowing where it came from and that passive manipulation is not nothing. Go
After investigating and discarding (leg pain due to dysfunction of the posterior tibial overloading the PLL), has found a point of maximum pain tibial malleolus area supports a well tenosynovitis of the tibialis posterior or long flexor of the hallux, which in turn causes inflammation of the posterior tibial nerve neuritis which gives the symptoms of hypoesthesia, tingling.
A taping, anti-inflammatories and the problem is resolved in 14 days. Need a plant support to treat posterior tibial dysfunction, but the patient refuses.

In another case, a child with Sever, and treated with insoles, NSAIDs, rest, etc, again due to relapse and see what you can do. Presents a plantar wart on the heel, pain on palpation of Sever, Achilles tendonitis and tendinosis of the peroneus longus (as NMR), magnetic resonance imaging performed in other post the radiologist may see a bone cyst in the area. On the radiograph is not seen nothing, and on MRI a few months earlier.

As we see, there are cases that are very complicated, both for ourselves and for any other professional. To err is human and what we do and continuously over the years. Medicine is not 1 +1 = 2, but it is a constant struggle for knowledge, for knowledge. Not bad
professional malpractice or being bad at your job that mistake, that we fail, that does not solve some cases. What if it would be good is to have several patients tell us, "it hurts here," and we let fall those words in a drawer from which he never will.
We have several differential diagnoses for each disease, search for questions, question, test treatments, good or bad result, but after all, alternatives.
Certainly there who is more specialized in one field, so that others can not cope, cover correctly, but is normal, time is finite and if you dedicate yourself to something you will not have time for another.

Almost everyone has started the way in which wrong will fail and the agenda, but it will not stop trying to find the solution.

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Day of Pharmacology. Conclusions






After I go to university course theoretical and practical limitation in podiatry, I can say I've seen the best course of all those I have.

When I say better, because it was the course that I was more able to assimilate in one day, to have kept almost all concentration during 10 hours without lowering our guard for a second, where we have absorbed every second and every word that the two wonderful speakers have commented.

Dr. Carlos Rodriguez, MD and specialist in Clinical Pharmacology, Professor of the University of La Coruna, who already knew of us taught at the Diploma in Podiatry.
Their presentations are very clear, focused directly on clinical practice (this had a lot to the organizers at the time of preparing the program) that has given us new knowledge and strengthen those who already had.

Dr. Carmen Durán, Doctor of Pharmacy and Clinical Pharmacology Specialist, Primary Care Pharmacy.
We were surprised at all since their papers on topics such as antiplatelet, anticoagulant and diabetes, in which everyone assumed that we would be overwhelmed by names of many prescription medications that rarely, but has not been well, thanks to its exposure we have learned much about these drugs.

All this information has explained both doctors, have been broken up, analyzed thoroughly, and we have squeezed all questions, solve all our doubts and problems that came up and giving us confidence in other medicines less commonly used in podiatry but have encouraged us to give them as would be the major and minor opiates and oral corticosteroids.

clinical cases have been very useful, we discussed first in groups and then between all the various cases we have some trapping, and addressed various pathologies from the well-known diabetes to gout.

We have encouraged at all times to prescribe, to that because we do from scratch, do it well, such is the rational use of antibacterial spectrum first using shorter and go up, something that almost everyone knew but few they made.
also scales acute and chronic pain according to WHO, since non-steroidal painkillers such as acetaminophen to opioids, when and how to prescribe them.

have also been issues with room for controversy as the use of Bleomycin. We are told that if it is not indicated in the prospectus, which can not be used because you risk "As you lose hair, and although many studies have been talking about its effectiveness is useless when a complaint. The only thing that could serve as a mitigating factor in a case of complaint is that the information set that is used for tumors and may consider a wart a benign tumor. We recommend that if you do use an informed consent.

For colchicine, advised us not to use it, but appears in many clinical guidelines as an effective treatment for gout, adverse effects are very important as it is an antimitotic. Full-dose NSAIDs are equally effective and better tolerated.

disproportionate use gastroprotective, gastric protectors have some indications and include a history of gastric ulcer patients over 65 years as the most important indications for what can not be used systematically.

Patients taking NSAIDs such as ibuprofen for months, after 2 to 3 months reduces the risk of injury
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We have different types of prescription are: prescription complacent, which is what we use for the patient wear something because it is required, the prescription defense, which is used too, especially antibiotics, in which broad-spectrum because we doubt our opinion diagnosis and we cover everything to be safer, when what we are doing is to create more resistance to more types of bacteria.

neuropathic pain, the use of antiepileptic drugs.
treatments in patients anticoagulation and antiplatelet agents.
The malpractice being committed systematically at national level all kinds of professionals, from us to doctors.

also advised us not to withdraw antiplatelet drugs to patients before minor surgery with little risk of bleeding, since in the most prestigious journals is absolutely forbidden, but if surgery is higher, you can do what has already been done, suspender el tratamiento durante el tiempo necesario para cada uno, y mientras administrar heparinas de bajo peso molecular.

Un punto importante de las prescripciones, es el seguimiento del paciente, no podemos dar un medicamento y mandarlo venir al cabo de 2 semanas, ya que todos los medicamentos tienen sus efectos adversos y reacciones medicamentosas, por lo que es preciso realizar un seguimiento a corto plazo de la evolución tanto de la patología como del fármaco para poder valorar problemas o que no está mejorando la sintomatología que presenta el paciente.

Hemos visto antibiogramas y análiticas, interpretarlas y en casos de pacientes con dislipemias recomendarles indicaciones para mejorar your health, because as our speakers have said, we are professionals and that is also part of our work.


Finally, we have provided contact with them to perform at any moment all questions that we come up. We have supported
new prescribers as encouraging us to do so without fear, but with consistency, with great power comes great responsibility.

As always, the relationship between all partners has been exemplary, going back to see old friends and meeting new ones in a very cordial and pleasant climate.

In conclusion, it has been a most useful course, all have come up with a good taste, so we as the speakers because they have seen that our level was not as low as previously thought.