seekerofwisdom
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Post by seekerofwisdom on Jul 18, 2009 6:21:16 GMT
I am an FHP and a new poster. I have a new patient with callus on their heels. The callus overlaps like fish scales and is very difficult to remove without cutting the patient. I have never seen this before. I have suggested they use a moisturiser and a footfile, what else can I tell them? How can i remove it safely? Thank you in advance for your help.
NP
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seekerofwisdom
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Post by seekerofwisdom on Jul 18, 2009 7:18:37 GMT
Without wishing to be derisory, this is a very common presentation and well within the capabilities of a Podiatrist.
If you cannot deal with this you should seriously question your training.
For the sake of your client find a qualified practitioner and refer on.
Shy.
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seekerofwisdom
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Post by seekerofwisdom on Jul 18, 2009 9:07:39 GMT
David.
Why on earth would Shy want to do that?
Shy has helped Robert get this site moving again, why would Shy want to undo that.
Your intuition is waning David, but I'm sure the FHP will enjoy the Karma.
Have you noticed that there are many posters using the anonymous facility so it is impossible to allocate the Karma to an individual.
Perhaps NP FHP would like to join the merry band then get the Karma transfered?
In the meantime perhaps you would like to be more constructive than me and give NP the benefit of your experience.
Shy.
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Post by michellet on Jul 18, 2009 15:45:47 GMT
NP.
don't mind these two. Shy obviously feels it below his dignity to help anyone and prefers to chuck rocks.
I've seen the sort of thing you're talking about. My advice (helpful and practical ) is as follows.
When you're sharp debriding do it against the scales not under them and use a slicing motion with a 10 blade rather than ascraping motion with a 15.
better yet, use a moors disc
do it little and often and the "depth" of the scales will reduce.
if the patient is diabetic, had crap circulation or is on steroids its all a bit risky and probably best to refer on as shy said
since i'm "on a warning" from admin i can't say what i think of shy. but i will say this. it not all about you and your crusade against fhps. You've made your views obviou, can we move on?
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hilo
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Post by hilo on Jul 18, 2009 16:04:51 GMT
michellet
helpful though your post is intended to be , would it not be better to establish the aetiology of this type of callus ? From the description given by NP FHP, it is not normal keratosis.
Perhaps you could have a guess at what it might be?
Hilo
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seekerofwisdom
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Post by seekerofwisdom on Jul 18, 2009 16:31:48 GMT
Michellet,
First I have to agree with Hilo.
Second I do not have a 'crusade against FHPs'. Please feel free to say what you think of me and I will ask Admin to let it stand.
What I do have is a campaign for the protection of 'unsuspecting clients' who responds to clever advertising and believes the person attending them is fully competent.
Explaining how to deal with a presentation I believe is unacceptable. The major issue between Pods and the privately educated is the lack of supervised clinical time thus producing 'practicers' who 'learn on the job. Reading about it is not the same as doing it and being supervised.
Clearly you are a grand parented pod/FHP as you have been taught to use the No 10. This blade is very good for craft work but I certainly cannot use it to debride callus, so my advice would have been useless.
Perhaps you should PM the NP and offer some supervised instruction, as your description leaves much to be desired?
Michellet, why do you remind me of someone else?
Shy
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10feet
Junior Member
Posts: 68
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Post by 10feet on Jul 18, 2009 18:50:14 GMT
Dear all
I assumed the intention behind rebranding this forum was to improve the quality and depth of debate, engage with new posters and offer support to the administrators.
This thread is deteriorating into the usual mud slinging and throughout the forum the same personalities are controlling events. All I can say is give Robert a break and support him in his aims.
Therefore, Mr Administrator, can we have an explanation in the left hand column, as we face the screen, explaning the sentiments behind SeekerofWisdom being an anonymous facility. Posters using this log in are encouraged to identify themselves by a signature as NP, Sunseeker and Shy have done.
Come on all, Michelle and Derek included, move on and allow this forum to develop into a useful UK resource.
PTP
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Post by Admin on Jul 18, 2009 19:51:39 GMT
Thanks Pete. Appreciate the support and understanding!
You surely can have a comment in the left column for seeker. Limited by space of course but I'll get on it.
The thinking behind seeker is to meet the needs of those who don't want to register (for whatever reason) to have a way to have a say. Like you say they need to identify themselves so we can tell all the seekers apart!
Sunseeker, shy and a few others seem to have the idea.
As Pete says there is a danger that these threads become repetative. At the risk of doing the same and repeating MY self, I think the FHP training debate IS an important one but its not the only show in town.
Regards Admin
Roberts opinion.
That said, I think Shy makes a good point. There are some things, including methods of debridement, which really need to be shown rather than explained. So my personal advice to NP would be that if you're not confident to do it, don't. It won't do your business any good if you do poorly and patients don't like it when they leave bleeding. Reputations are built and broken on such things.
Hilo, don't be coy. If you think you know what this is how about you tell us what you think. That would, to paraphrase pete, help this thread to be a useful resource.
Regards Robert
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Post by blinda on Jul 18, 2009 20:57:04 GMT
Hi All, My tuppence worth; without pictures it is very difficult to offer an opinion as `fish scale` type callus could be descriptive of many dermatological conditions. Eg. Darier disease, actinic porokeratosis, palmoplantar keratodermas, lichen planus (don`t forget to look in the mouth too), cutaneous lupus erythematosus, seborrhoeic dermatitis, psoriasis, etc. However, the classic fish scale manifestation can indicate ichthyosis, which is rare but I have seen it. NP, did the medical history reveal any systemic condition associated with the thyroid or any other acquired disease such as HIV or carcinoma? With ichthyosis, treatment consists of daily moisturising, preferably with a product containing urea, and exfoliation to help prevent anhidrosis, scaling and fissures in the epidermis. I agree that careful reduction of these scales is possible with a 10, 11 or 15 or moores disk (I use all of them ), but as others have wisely advised, if you do not feel confident in treating this pt, please do refer on. Cheers, Bel
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hilo
New Member
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Post by hilo on Jul 18, 2009 21:57:07 GMT
Bel
You beat me to it. But what I would add is that common conditions are common- dont look for something rare too quickly. I would say that the majority of the cases I have treated have been psoriasis , severe eczema, a handful of cases I can remember of keratodermas and maybe only one each of some of the other rarer conditions.
The subject of dermatology is best learnt or revised by a good visual resource-there are many on the internet, and one of my favourite books is Text Atlas of Podiatric dermatology by Dawber,Bristow and Turner.
Hilo
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Post by dtt on Jul 19, 2009 10:49:17 GMT
Scuze me Pete Where did I get included in this I think I have been very restrained and am avoiding the wind up merchants so nothing goes into the old ways. I support Robert and the principle behind this forum and wish it and him every success. Cheers Derek
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seekerofwisdom
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Post by seekerofwisdom on Jul 19, 2009 13:06:12 GMT
Derek
I have to agree with you here- you have indeed been restrained. There have been many times I would have banned you in a previous life had I been a moderator. However, let us hope that you have indeed changed your ways for the sake of Robert and what could become a good foum.
Is it really necessary do you think, to continue to have the troll finder general logo at the bottom of your posts? Are we not in a different ball park here?
sunseeker.
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Post by blinda on Jul 19, 2009 13:37:38 GMT
Hey Hilo,
Sorry, didn`t mean to knock the wind out of yer sails, but yes I totally agree `common conditions are common`. I often quote one of the authors favourite sayings of the Atlas you mention;”When you hear hooves, think horses not zebras”. I have only seen one case of ichthyosis but the scales were very distinct.
Another valuable tool in derm conditions is Dockery`s Cutaneous Disorders of the Lower Extremity. Dave S teased me with it at Roberts CPD day but my resistance was futile. I had to buy it as it gives very detailed descriptions of each condition, with vivid colour photographs. The dermatology flow sheets are easy to follow and diagnostic tests and treatment recommendations are also good.
Cheers, Bel
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Post by dewdrop on Jul 20, 2009 6:00:11 GMT
DTT I do not understand your remarks (reply 11 ) about "wind-up merchants"? Who are they?
You must admit that Shy (reply 7 ) makes some very good points regarding the privately trained. I think these warrant further discussion, maybe on a new thread?
David H, I am surprised that you have not offered advice to the new poster? After all you were quoted as saying that "today's freshly-minted FHPs are well- trained " ?
Unfortunatley, I cannot make a comment on the contents of the original post as I have be reprimanded by admin for being too blunt.
I agree with Sunseeker that the "Trollfinder" Logo should go as this is a new forum now.
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Post by Admin on Jul 20, 2009 6:25:57 GMT
Hmmm. I would describe a wind up merchant as someone who posts deliberatly inflamatory posts in order to provoke an inflammatory reaction rather than to edify the community and move the debate forward. Often they are characterized by attacks or examinations of individual posters rather than the issues they are discussing.
I would agree with DTT that he has been very restrained and would applaud that.
Dewdrop you can be as blunt as you like, but only about the ISSUE not the individuals. And if it's on topic of course.
Reagards Admin
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