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Palliative Care

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Why Do We Reduce Toenails? Reduce pain

Prevent potential injury Subungual

ulceration Subungual

hematoma

Cosmesis

Not everyone is a candidate for definitive treatment

Reducing a toenail: Step 1—assess the patient

PVD?

Neuropathy?

Other immunocompromise?

Reducing a toenail: Step 2—collect needed materials

Gloves

Eye Protection

Gauze

Nail nippers

Bandaids

Reducing a toenail: Step 3—stabilize the toe

Reducing a toenail: Step 4—Reduce the toenail

Reducing a toenail: Watch for flying toenail

Don’t try this technique with thick toenails

Reducing a toenail: How far back do you cut?

Depends on the condition of the toenail

Reducing a toenail: Step 5—Smooth the nail surface

Reducing a toenail: Podospray

Why reduce corns and calluses?

Pain

Potential ulceration

Difficult definitive treatment

Not all patients are good candidates for surgical treatment

Corn Synonyms

Heloma durum (HD)

Excrescence

Hyperkeratosis

Hyperkeratotic papule

Callus Synonyms

Tyloma

Intractable Plantar Keratosis

Hyperkeratotic papule

Debriding a callus: Step 1—assess the patient

PVD?

Neuropathy?

Other immunocompromise?

Debriding a callus: Step 2—Gather appropriate materials Gauze

Blade handle

Blade

Kelly Forceps

Gloves

Debriding a callus: Step 3—Load the blade

Debriding a callus: Step 4—Hold the Blade

Debriding a callus: Step 4—Hold the Blade

Debriding a callus: Step 4—Hold the Blade

Debriding a callus: Step 5—Don’t forget negative pressure

Debriding a callus: Step 6—When do you stop?

Blood Color Texture Skin Lines

Palliative Foot Care: What if you see blood?

Don’t say “oops” Inform the patient Hemostasis Clean with alcohol Dress with antibiotic Cover with a

bandaid Patient instructions Follow up

Hemostatic solutions

Palliative Foot Care: Billing Issues

C&C is not covered by Medicare, unless…

Normal toenails are not covered by Medi-Cal

Most private insurance co’s do not cover C&C