Intractable Plantar Keratosis Workup

Updated: Sep 29, 2022
  • Author: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS; Chief Editor: Thomas M DeBerardino, MD, FAAOS, FAOA  more...
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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. [30]


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.


Other Tests

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


Histologic Findings

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