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Intractable Plantar Keratosis Workup

  • Author: Noah S Scheinfeld, JD, MD, FAAD; Chief Editor: Jason H Calhoun, MD, FACS  more...
 
Updated: Jan 20, 2016
 

Laboratory Studies

Standard preoperative tests are indicated.

Pedobarography provides numeric information regarding dynamic and static foot pressure. However, one study found the diagnostic validity of pedobarography to be low for intractable plantar keratosis (IPK) related to metatarsophalangeal (MTP) dislocation in rheumatoid arthritis.[25]

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Imaging Studies

Weightbearing radiography should be performed for IPK. Anteroposterior (AP), lateral (LAT), and forefoot axial (FtAx) projections are best. Images are reviewed for possible fractures, metatarsal avascular necrosis (AVN), or accessory sesamoids. The metatarsal parabola should be noted, as well as the sagittal plane of the metatarsal heads on the FtAx view.

A radiopaque marker can be used to indicate the exact location of the lesion in the soft tissue.

If the lesion is overlying the first MTP sesamoids, the FtAx view is useful for evaluating for fracture of the sesamoid, as well as for gauging the overall size of the sesamoid.

A Harris mat can be used to determine pressure areas.

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Other Tests

Nerve conduction studies, electromyography (EMG), and noninvasive vascular testing may be used if indicated on the basis of the clinical history. As a rule. these tests are rarely indicated in the workup of IPK.

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Histologic Findings

Analysis of a biopsy specimen of IPK will show hyperkeratosis and inflammation.

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Contributor Information and Disclosures
Author

Noah S Scheinfeld, JD, MD, FAAD Assistant Clinical Professor, Department of Dermatology, Weil Cornell Medical College; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Assistant Attending Dermatologist, New York Presbyterian Hospital; Assistant Attending Dermatologist, Lenox Hill Hospital, North Shore-LIJ Health System; Private Practice

Noah S Scheinfeld, JD, MD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Abbvie<br/>Received income in an amount equal to or greater than $250 from: Optigenex<br/>Received salary from Optigenex for employment.

Coauthor(s)

Christopher F Hyer, DPM, FACFAS Foot and Ankle Surgeon, Director, Advanced Foot and Ankle Surgery Fellowship, Orthopedic Foot and Ankle Center

Christopher F Hyer, DPM, FACFAS is a member of the following medical societies: American College of Foot and Ankle Surgeons, American Podiatric Medical Association

Disclosure: Received consulting fee from Wright Medical Technology for consulting; Received royalty from Wright Medical Technology for consulting; Received consulting fee from Amniox for consulting; Received consulting fee from Stryker for none; Received consulting fee from Biomet for none.

Mark Loebenberg, MD, FAAOS Consulting Staff, Department of Orthopedic Surgery, Assaf HaRofeh Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jason H Calhoun, MD, FACS Department Chief, Musculoskeletal Sciences, Spectrum Health Medical Group

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Michigan State Medical Society, Missouri State Medical Association, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, Texas Orthopaedic Association, Musculoskeletal Infection Society

Disclosure: Nothing to disclose.

Additional Contributors

Heidi M Stephens, MD, MBA Associate Professor, Department of Surgery, Division of Orthopedic Surgery, University of South Florida College of Medicine; Courtesy Joint Associate Professor, Department of Environmental and Occupational Health, University of South Florida College of Public Health

Heidi M Stephens, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Florida Medical Association

Disclosure: Nothing to disclose.

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