FEEL THE HEEL

FEEL THE HEEL

CHIDAMBARAM HOSPITAL
चिदंबरम अस्पताल,
ചിദംബരം ഹോസ്പിറ്റൽ
சிதம்பரம் மருத்துவமனை,
திசையன்விளை.627657

 

Piezogenic Pedal Papules

Piezogenic pedal papules are lesions that appear on the feet and wrists. These can either be accompanied by pain or be asymptomatic and they usually take the form of papules. It seems that they appear when fat herniates through the dermis, having a characteristic popular appearance. This is a common medical condition and generally asymptomatic in the majority of people. It is not genetically inherited and it is not related in general to connective tissue disease (in certain cases, it might be associated with such conditions but this is not a direct cause). As for the actual papules, these become obvious when the person stands up, distributing the entire body weight on the heels.

 

Symptoms of Piezogenic Pedal Papules

These are the most common symptoms of the piezogenic pedal papules:

• Skin lesions in the form of papules appear on the feet and wrists
• Pale to skin-colored
• Obvious when weight is distributed on the feet (standing up), disappear when the person sits down and the weight is reduced
• Bilateral involvement
• Most often affects the heel of the foot, including the medial, posterior and lateral side
• In the wrist, the volar surface is the one most affected (because of the pressure)
• Pain might accompany the papules, preventing the person from performing certain activities
• The papules present on the feet or wrists can be easily compressed

What are the Causes of Piezogenic Pedal Papules?

These are the most common causes associated with the appearance of the piezogenic pedal papules:

• Excessive weight – obese patients have more weight to bear on their feet and this is why they present an increased risk for fat to herniate through the dermis layer of the skin
• Occupation
  • Standing for prolonged periods of time
  • Constant pressure applied to the wrist
• Associated with Ehlers-Danlos syndrome (collagen disorder)
• Idiopathic (unknown cause)
• Orthopedic problems
  • Flat feet
• Can occur in newborns (no predisposition)
• Excessive weight bearing (physical exercise or other vigorous physical activity)
• Repetitive pressure force on the said areas
  

Diagnosis

These are the most common methods used for the diagnosis of piezogenic pedal papules:

• Clinical examination
  • Identification of fat herniating through the dermis
• No laboratory analysis
• No imaging studies
• Differential diagnosis – this can be made with the following medical conditions:
  • Infantile pedal papules (bilateral congenital adipose plantar nodules/precalcaneal congenital fibrolipomatous hamartomas/pedal papules) – appear in newborns
  • Xanthomas – painful lesion that occurs most often on the buttocks but can affect other areas of the body as well
  • Tophi – appear in patients with gout, being represented by solid urate that deposits in the connective tissue.
    

Treatment

These are the most common treatment courses and recommendations made for people diagnosed with piezogenic pedal papules:

• No oral or topical medication available or necessary
• Orthotics and other devices are recommended in patients who exhibit symptoms
  • Supportive external pressure device
  • Heel taping
  • Compression stockings
  • Foam rubber foot pads
  • Foam-fitting plastic heel cups
• Rest and elevation might help with the symptoms (temporary relief)
• Non-surgical approach
  • Injections with betamethasone and bupivacaine – these are recommended for patients who have been diagnosed with Ehlers-Danlos syndrome, reducing the painful symptoms. Repeated injections are necessary for complete pain relief.
• No surgery has proven to be effective for the treatment of piezogenic pedal papules but the surgical approach can be recommended for a skin lesion that is persistent and intensely painful.
• Avoiding periods of prolonged standing, walking or running can help if the papules are painful (practically, the patient is recommended avoid any kind of physical activity that might involve excessive or prolonged weight bearing)
• In case of excessive weight, patients are recommended to follow a weight loss program
• Recent studies recommend electro-acupuncture as treatment for this medical condition.

 

 

CHIDAMBARAM HOSPITAL
चिदंबरम अस्पताल,
ചിദംബരം ഹോസ്പിറ്റൽ
சிதம்பரம் மருத்துவமனை,
திசையன்விளை.627657

- தீவிர சிகிச்சை மருத்தவம்
- பொது மருத்துவரம்
- பொது அறுவை சிகிச்சை
- குழந்தை அறுவை சிகிச்சை
- குழந்தை லேப்ராஸ்கோப்பி அறுவை சிகிச்சை
- Cesarean section
- Dilation and Curettage
- Vulvectomy
- Tubal Ligation
- Trachelectomy
- Selective Salpingography
- Myomectomy
- Hysterosalpingography
-Endometrial or Uterine Biopsy
- Colporrhaphy
-Vaginal hystectomy
- Appendicitis
- Lymphangioma
- Cleft lip and palate
- Esophageal atresia and tracheoesophageal fistula
- Hypertrophic pyloric stenosis
- Intestinal atresia
- Necrotizing enterocolitis
- Imperforate anus
- Undescended testes
- Omphalocele
- Gastroschisis
- Hernias
- Teratomas
- Amputation
- Appendectomy
- Cholecystectomy
- Colectomy
- Cystoscopy
- Hemorrhoidectomy
- Hysterectomy
- Hysteroscopy
- Inguinal Hernia
- Laparoscopy
- Mastectomy
- Thyroidectomy
- Tracheostomy
- Tonsillectomy and Adenoidectomy
- Umbilical Hernia
- லேப்ராஸ்கோப்பி அறுவை சிகிச்சை
- மகப்பேறு மருத்துவம்
- தாய்மை மருத்துவம்
- மகளிர் நோய் இயல்
- சர்க்கரை வியாதி மருத்தவம்
- X - ரே (X-Ray)
- ஈசிஜி (ECG)
- இரத்த ஆய்வு (Blood Investigation LAB)
- அல்ட்ராசவுண்ட் ஸ்கேன்
(ULTRASOUNDSCAN)
- பிசியோதெரபி பயிற்சி (PHYSIOTHERAPY)
- முக வாதம் தூண்டுதல் பயிற்சி (BELLS PALSY STIMULATION)
- துரக்கம்-முதுகு வலி நிவாரணத் பயிற்சி(TRACTION)
- மெழுகு ஓத்தLம் (WAX BATH)
- அகச்சிவப்பு கதிர் வலி நிவாரணத் ஓத்தLம்(INFRA RED Hot Fermentation)


Dr.M.I. கிறிஸ்டோபர் சாமுவேல் MBBS,MS.,FIAGES.,லேப்ராஸ்கோப்பி அறுவை சிகிச்சை நிபுணர்.,
DR.அலெக்ஸ் J கிறிஸ்டோபர் MBBS,MS,MCH.,(PAEDIATRIC SURGEON),லேப்ராஸ்கோப்பி அறுவை சிகிச்சை நிபுணர்.,
DR.அருண் G கிறிஸ்டோபர் MBBS,MD(Anaesthesia)மயக்க மருந்து நிபுணர்,Pain Management., Dip.Diab., சர்க்கரை வியாதி மருத்துவர்.,
PT.அந்தோணி றீகன் B.P.T
(பிசியோதெரபி நிபுணர்)MCSE,COPA,D.Pharm., 

“Win The Fight Before It Starts…..Test For TB”

 “Tuberculosis: Feels Good Get That Off My Chest”

CHIDAMBARAM HOSPITAL
चिदंबरम अस्पताल,
ചിദംബരം ഹോസ്പിറ്റൽ
சிதம்பரம் மருத்துவமனை,
திசையன்விளை.627657

“Nature is that lovely lady to whom we owe polio, leprosy, smallpox, syphilis, tuberculosis, cancer.”

 “Be Aware Cuz TB Is Out There!”

Generally, tuberculosis affects the lungs (known as pulmonary tuberculosis) but may spread to other organs including the lymph nodes, gastro intestinal tract, genito-urinary tract, brain, coverings of the brain (meninges) or heart (pericardium), bones, joints, skin, eyes or almost any other organ in the body. Only the hair and nails are not affected by TB.

When a person is infected with pulmonary tuberculosis, the bacteria in the lungs multiply and cause pneumonia along with chest pain, hemoptysis and a prolonged cough. The lymph nodes near the heart and lungs become enlarged. As the TB bacteria tries to spread to other parts of the body, the body's immune system often interrupts the process and forms scar tissue or fibrosis around the TB bacteria. This helps fight the infection and prevents the disease from spreading in the body and to other people. If the body's immune system is unable to fight the bacteria the disease returns to an active state with pneumonia and damage to kidneys, bones, and the meninges that line the spinal cord and brain.

Tuberculosis can be classified as latent or active.

Latent tuberculosis is when the bacteria in the body are in an inactive state and the person shows no symptoms. Latent tuberculosis is not contagious.

Active tuberculosis is contagious and can make a person sick.

TB is spread through the air when people with an active pulmonary tuberculosis infection cough, sneeze, shouts or spit.

The treatment can continue for several months and the patient has to take the medicines at the given time regularly for the prescribed duration. If TB medications are not taken as per the healthcare providers recommendations the infection may become much more difficult to treat and sometimes the TB bacteria may become resistant to treatment.

TB is a preventable disease. BCG vaccination is given to people in countries where there is high prevalence of tuberculosis.

Lately the incidence of tuberculosis is increasing due to increased HIV cases and appearance of drug resistant strains of TB.

In 1826 a physician Laennec said this about tuberculosis -
"Whatever the form in which the tuberculous matter develops, it begins as a grey, semi-transparent matter that little by little becomes yellow, opaque, and dense. Then it softens, and slowly acquires liquidity like pus. This pus when expelled through the airways leaves cavities, commonly called ulcers of the lung; that we will designate as tuberculous excavations."
-Rene-Theophile-Hyacinthe Laennec, 1826

How does Tuberculosis Spread?

Tuberculosis infection generally involves the lung tissue and is called pulmonary tuberculosis.

Pulmonary TB can be of two types based on whether the patient produces the TB germs in his sputum or not-

Patients who have TB germs in the sputum are called sputum positive pulmonary TB patients.

Patients whose sputum is negative are called the sputum negative pulmonary TB patients.

Generally the sputum positive TB patients are the people who spread the disease in the community. A single infected untreated person can spread the disease to 10-15 individuals in his community.

Tuberculosis is transmitted from an infected person to a susceptible individual through airborne particles known as droplet nuclei. Tuberculosis bacteria are not transmitted by surface contact. This means touching cannot spread tuberculosis unless the bacteria are breathed in.

The infectious droplet nuclei, 1–5 microns in diameter, are tiny water droplets with the bacteria that are released when people with active pulmonary or laryngeal tuberculosis cough, sneeze, laugh, shout, speak etc. The droplet nuclei remain suspended in the air for up to several hours.

Infection with tuberculosis germs does not denote disease. The initial infection might not be associated with any symptoms. The germs are harbored in the body and they lie in the dormant state. 10% of the people who harbor the infection develop the disease in a time span of 60 years.

The chances of developing tuberculosis disease in such an infected person becomes higher when the person’s immunity goes down in conditions such as diabetes, cancer, chronic illness, malnutrition, HIV or treatment with immunosuppressive drugs as in after transplant surgery.

People who are at an increased risk of tuberculosis -

Infants
Elderly people
People with weak immune systems due to AIDS, chemotherapy, diabetes or immunosuppressant medicines.

What are the Symptoms of Tuberculosis?

A person infected with TB is usually symptom free. Once the infection flares into disease the patient has symptoms like-

Cough for 3-weeks or more. Coughing up of sputum and/or blood.



Evening rise of temperature
Fever
Chills
Night sweats
Loss of appetite
Weight loss
Chest pain
Difficulty in breathing
Shortness of breath
Tiredness
Fatigue

How can we Diagnose Tuberculosis?

Tuberculosis symptoms can be diagnosed using sputum test, Mantoux test, chest X-ray, CT scan and blood tests.

Sputum test -

Microscopic sputum analyses or cultures can find Tb bacteria in the sputum.

Three sputum samples (2 on the spot and 1 overnight collection) are collected and tested. Based on the results the patients are classified as-

If the sputum is positive then the patient is sputum positive TB patient.
If the sputum is negative but the Chest X-ray shows features suggestive of active TB then the patient is a sputum negative TB patient.

Mantoux test -

The most common diagnostic test for tuberculosis is a simple skin test called the Mantoux test. This test consists of a small amount of purified protein derivative (PPD) tuberculin that is injected into the forearm.

The test results are noted after 48 to 72 hours. A hard, raised red bump at the injection site usually indicates a positive test for TB.
Chest X-ray and CT-scan of lungs -

Chest x-rays and computer tomography (CT) scans of the lungs are also used to diagnose TB.

If the immune system traps the tuberculosis bacteria and creates scar tissue, this tissue and the lymph nodes may harden like stone in the calcification process. This results in granuloma i.e. rounded marble-like scars that often appear on X-rays and CT scans.

Blood tests-

Blood tests may also be used to determine whether TB is active or latent (inactive).

Other tests for diagnosing pulmonary TB are-

Bronchoscopy
Bronchoalveolar lavage
MRI of lungs
Lung biopsy
Fundoscopy
Biopsy of the affected tissue (rare)
Interferon-gamma release blood test such as the QFT-Gold test to test for TB infection
Thoracentesis

How can Tuberculosis be Treated?

Tuberculosis can be treated by taking a combination of antibiotics (usually 3-5 drugs) for a period of 6-8 months.

The treatment of tuberculosis depends on whether it is active or latent. Latent tuberculosis is treated with isoniazid (INH) for 6-12 months. Drugs that may be used to treat active Tuberculosis include-

Isoniazid
Rifampin
Pyrazinamide
Ethambutol
Amikacin
Ethionamide
Moxifloxacin
Para-aminosalicylic acid
Streptomycin

The treatment has to be taken regularly for the prescribed duration. A good nutritious diet is helpful. A kerchief or a bit of cloth or tissue should be used while coughing or sneezing; and sputum should not be spit anywhere. Instead the sputum should be collected in a container and buried or burnt.

The common side-effects of anti-Tuberculosis drugs are-
Nausea
Vomiting
Headache
Joint pain
Vision disturbance
Orange or brown colored urine and/or tears
Skin rash
Dizziness
Jaundice (rare)

Vaccination against Tuberculosis- BCG vaccination has to be taken under the Universal Immunization Program. BCG vaccine is given soon after birth and protects against developing the severe forms of TB in childhood but does not protect adults from developing the adult forms of pulmonary TB.

A new tuberculosis vaccine, called H56(January 23,2011), has been more effective in preventing TB in infected mice than the current vaccine. The vaccine is still undergoing clinical trials.

Home Treatment for Tuberculosis

Taking prescribed medicines -

The home treatment for tuberculosis focuses on taking the medicines correctly to reduce the risk of developing multidrug-resistant TB. It is advised the patient-

Keep regular follow-up with the doctor.
Take the medicines as prescribed.
Report any side effects of the medicines.

Healthy eating and exercise -

Eating healthy foods, getting enough sleep and doing some exercise during the treatment regime helps to fight the TB infection. A balanced meal comprising of enough protein and calories help to control the weight loss.

Eat smaller meals several times a day instead of a few large ones.
Drink high-calorie protein shakes or other nutritious drinks between meals.
Drink peppermint or ginger tea.
Exercise and stay active. Walking is the best form of exercise.

Emotional issues

As the TB treatment takes long, patients may have trouble coping.

Many patients often feel embarrassed about having TB, or feel isolated or depressed, or are worried about losing their job in the course of the treatment.

A counselor or social worker can help cope with such emotional issues.

Preventing the spread of TB -

A person infected with TB can easily spread the disease to others until he/she has been on antibiotics for about 2 weeks.

Undertake the following measures to prevent the spread of TB-

Do not go to work or school while the TB infection is in the active phase.
Ensure proper ventilation of the patient’s room.
Cover the mouth while sneezing or coughing. Dispose of the soiled tissues in a covered container or burn them. 

 

 

CHIDAMBARAM HOSPITAL
चिदंबरम अस्पताल,
ചിദംബരം ഹോസ്പിറ്റൽ
சிதம்பரம் மருத்துவமனை,
திசையன்விளை.627657

- தீவிர சிகிச்சை மருத்தவம்
- பொது மருத்துவரம்
- பொது அறுவை சிகிச்சை
- குழந்தை அறுவை சிகிச்சை
- குழந்தை லேப்ராஸ்கோப்பி அறுவை சிகிச்சை
- Cesarean section
- Dilation and Curettage
- Vulvectomy
- Tubal Ligation
- Trachelectomy
- Selective Salpingography
- Myomectomy
- Hysterosalpingography
-Endometrial or Uterine Biopsy
- Colporrhaphy
-Vaginal hystectomy
- Appendicitis
- Lymphangioma
- Cleft lip and palate
- Esophageal atresia and tracheoesophageal fistula
- Hypertrophic pyloric stenosis
- Intestinal atresia
- Necrotizing enterocolitis
- Imperforate anus
- Undescended testes
- Omphalocele
- Gastroschisis
- Hernias
- Teratomas
- Amputation
- Appendectomy
- Cholecystectomy
- Colectomy
- Cystoscopy
- Hemorrhoidectomy
- Hysterectomy
- Hysteroscopy
- Inguinal Hernia
- Laparoscopy
- Mastectomy
- Thyroidectomy
- Tracheostomy
- Tonsillectomy and Adenoidectomy
- Umbilical Hernia
- லேப்ராஸ்கோப்பி அறுவை சிகிச்சை
- மகப்பேறு மருத்துவம்
- தாய்மை மருத்துவம்
- மகளிர் நோய் இயல்
- சர்க்கரை வியாதி மருத்தவம்
- X - ரே (X-Ray)
- ஈசிஜி (ECG)
- இரத்த ஆய்வு (Blood Investigation LAB)
- அல்ட்ராசவுண்ட் ஸ்கேன்
(ULTRASOUNDSCAN)
- பிசியோதெரபி பயிற்சி (PHYSIOTHERAPY)
- முக வாதம் தூண்டுதல் பயிற்சி (BELLS PALSY STIMULATION)
- துரக்கம்-முதுகு வலி நிவாரணத் பயிற்சி(TRACTION)
- மெழுகு ஓத்தLம் (WAX BATH)
- அகச்சிவப்பு கதிர் வலி நிவாரணத் ஓத்தLம்(INFRA RED Hot Fermentation)


Dr.M.I. கிறிஸ்டோபர் சாமுவேல் MBBS,MS.,FIAGES.,லேப்ராஸ்கோப்பி அறுவை சிகிச்சை நிபுணர்.,
DR.அலெக்ஸ் J கிறிஸ்டோபர் MBBS,MS,MCH.,(PAEDIATRIC SURGEON),லேப்ராஸ்கோப்பி அறுவை சிகிச்சை நிபுணர்.,
DR.அருண் G கிறிஸ்டோபர் MBBS,MD(Anaesthesia)மயக்க மருந்து நிபுணர்,Pain Management., Dip.Diab., சர்க்கரை வியாதி மருத்துவர்.,
PT.அந்தோணி றீகன் B.P.T
(பிசியோதெரபி நிபுணர்)MCSE,COPA,D.Pharm.,