Dermatologic manifestations of systemic disease.

As the body's point of contact with the weight-bearing surface, the foot resists abrasive forces and is constantly bombarded with dermatologic insults. It is the site of a variety of local and systemic afflictions, some which even indicate a state of relative emergency. Paying careful attention to the consideration and exclusion of serious or systemic conditions, this article presents an algorithmic approach that is useful in a clinical setting.

Keratotic lesions of the foot.

Keratotic lesions are widely encountered in daily podiatric practice. These conditions may represent widespread systemic illness, local and occult neoplastic disease, disorders of a genetic nature, or acquired states. Algorithms facilitate the categorization and final diagnosis of the plantar keratoses. Patients may return to normal lifestyles when mechanical, weight-dispersive, pharmacologic, or surgical therapeutic methods are employed to decrease or shield the thickened corneum.

Onychocryptosis.

Onychocryptosis is prevalent throughout the world and is most often the result of abortive self-attempts at curing the condition in its earliest stages. Its clinical presentation can often be confused with a number of osseous and soft-tissue abnormalities, some of which have great import to a patient's overall welfare. Treatment consists of local and systemic care, including nail avulsion. Recurrences are reduced when some form of effective matricectomy is used. Matricectomy techniques vary and must be selected on the basis of caregiver and patient preference.

Independent studies program in the basic sciences. A curricular innovation.

The Independent Studies Program was initiated at the New York College of Podiatric Medicine during the early months of 1987, and it has achieved continued success and acceptance from the administration, faculty, and students. The program emphasizes competence as the constant within a relatively time-independent framework. This paper presents, in a longitudinal fashion, the Independent Studies Program as a program model that combines criterion-referencing concepts, mastery-based learning combinations, and self-learning strategies. As a result, students have taken the initiative for diagnosing their learning needs, formulating their learning goals, identifying their human and material resources, and evaluating their learning outcomes.

Nail changes secondary to environmental influences.

Environmental medicine is a dynamic medical specialty that integrates medicine, mathematics, biology, and engineering. In this article an overview of how environmental agents affect the nail is presented. In addition, the three major routes of exposure (inhalation, dermal, and gastrointestinal) to environmental agents are discussed. Selected physical, chemical, and pharmaceutical agents and their effect on the nail structure are presented in the text.

Surgical management of hallux limitus and rigidus in the young patient.

As demonstrated in a recent survey, hallux limitus and rigidus are often the presenting complaints of our young population. Normal first metatarsophalangeal joint function depends not only on an intact articulation but also sesamoidal mobility and the capacity for the first metatarsal to plantarflex. Whereas acute or chronic microtrauma can impair articular surfaces, first metatarsal plantarflexion can be limited in cases of hypermobility, excessive metatarsal length, immobility of the first metatarsocuneiform joint, or metatarsus primus elevatus. Conservative therapy can be more effective in relieving the symptoms of hallux limitus or rigidus in young patients; however, surgical intervention is often necessary or desirable. The choice of surgical procedure should be based on the etiology of the deformity, as well as the degree of articular degeneration. It is the senior author's opinion that young patients with hallux limitus or rigidus are best served by the performance of cheilectomy with osteotomies designed to create an internal rocker bar mechanism. Procedures designed to shorten or plantarflex the first metatarsal should be reserved for obvious cases of excessive metatarsal length or elevation.

Occupational skin diseases of the feet.

Although dermatoses account for the vast majority of occupational disease, the role played by foot disorders is uncharted. Often, protective footgear has an etiologic rather than a therapeutic effect. The environmental, chemical, physical, and biologic causes of pedal skin disease in the workplace are described, with emphasis on the need for their recognition and control.

Dermatophytosis. A review of diagnosis and current therapy.

Inhibition of fungal growth and accelerated keratolysis are the necessary ingredients of dermatophyte therapy. Often, the primary fungus is destroyed by secondary bacterial invasion or the body's immune response. Clinicians must recognize this possibility and, in such instances, treat the bacterial infection or immune response rather than the suspected dermatophyte.