Fundamentals Of Nursing-(Foot) Essay, Research Paper
Pes cavus (clawfoot) refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot (see Fig. 626). The shortening of the foot and increased pressure produce calluses on the metatarsal area and on the dorsum (bottom) of the foot. CharcotMarieTooth disease (a peripheral neuromuscular disorder associated with a familial degenerative disorder), diabetes mellitus, and tertiary syphilis are common causes of pes cavus. Exercises are prescribed to manipulate the forefoot into dorsiflexion and relax the toes. Bracing to protect the foot may be used. In severe cases, arthrodesis (fusion) is performed to reshape and stabilize the foot.
Morton’s neuroma (plantar digital neuroma, neurofibroma) is a swelling of the third (lateral) branch of the median plantar nerve (see Fig. 626). The third digital nerve, which is located in the third intermetatarsal (web) space, is most commonly involved. Microscopically, digital artery changes cause an ischemia of the nerve.
The result is a throbbing, burning pain in the foot that is usually relieved when the patient rests. Conservative treatment consists of inserting innersoles and metatarsal pads designed to spread the metatarsal heads and balance the foot posture. Local injections of hydrocortisone and a local anesthetic may provide relief. If these fail, surgical excision of the neuroma is necessary. Pain relief and loss of sensation are immediate and permanent.
Flatfoot (pes plamis) is a common disorder in which the longitudinal arch of the foot is diminished. It may be due to congenital abnormalities or associated with bone or ligament injury, muscle and posture imbalances, excessive weight, muscle fatigue, poorly fitting shoes, or arthritis. Symptoms include a burning sensation, fatigue, clumsy gait, edema, and pain.
Exercises to strengthen the muscles and to improve posture and walking habits are helpful. A number of foot orthoses are available to give the foot additional support. Severe flatfoot problems are usually treated by an orthopedic surgeon or a podiatrist.
NURSING PROCESS: THE PATIENT
UNDERGOING FOOT SURGERY
Surgery of the foot may be necessary because of various conditions, including neuromas and foot deformities (bunion, hammer toe, clawfoot). Generally, foot surgery is performed on an outpatient basis. Before surgery, the nurse assesses the patient’s ambulatory ability and balance and the neurovascular status of the foot. Additionally, the nurse considers availability of assistance at home after surgery and the structural characteristics of the home in planning for care during the first few days after surgery. The nurse uses these data, in addition to knowledge of the usual medical management of the problem, to formulate appropriate nursing diagnoses.
Based on the assessment data, the nursing diagnoses for the patient undergoing foot surgery may include the following:
Risk for altered peripheral tissue perfusion related to surgical procedure
Pain related to inflammation and swelling
Impaired physical mobility related to the footimmobilizing device
Risk for infection related to the surgical procedure/surgical incision
Planning and Goals
The goals of the patient may include adequate tissue perfusion, relief of pain, improved mobility, and absence of infection.
Promoting Tissue Perfusion
Neurovascular assessment of the exposed toes every I to 2 hours for the first 24 hours is essential to monitor the function of the nerves and the perfusion of the tissues. If the patient is discharged within several hours of the surgery, the nurse teaches the patient and family how to assess for swelling and neurovascular status (circulation, motion, sensation). Compromised neurovascular function can increase the patient’s pain.