5-6
Thickened, dry skin over prominent bones (corn); larger patches of thickened, dry skin over friction areas from
walking (calluses); tenderness, blisters, breakdown and infection after continued irritation.
Assessment:
Differential Diagnosis
Wart, foreign body
Plan:
Treatment
Primary: Trim areas with #15 blade or beaver blade. Trim with #10 blade for larger callus areas. Place felt
with a doughnut-shaped hole cut in the middle (or pre-cut felt available over the counter) around area to
relieve pressure and friction. Medicated pads are not recommended.
Alternative: Pad around prominent areas without trimming to protect and prevent irritation.
Primitive: Sand callus or corn gently with abrasive stone
Patient Education
General: Daily foot inspections in the field if possible.
Prevention and Hygiene: Trim corns and calluses. Safest technique is to file areas with callus stone.
Inspect shoes for frayed seams or torn liner. Check shoe fit. Mitigate source of pressure and deformities.
Follow-up Actions
Evacuation/Consultation Criteria: Evacuation not normally necessary. Refer to podiatrist for orthotics or
surgery to correct deformities, or for other advanced foot care.
Podiatry: Stress Fractures of the Foot
CDR Raymond Fritz, MSC, USNRIntroduction: A stress fracture may affect any bone. The most common stress fracture in the foot, known in
the military as a march fracture, is the second metatarsal. Stress fractures are often seen in intense training
programs around week four, when bone absorption exceeds bone-building activity. Improper preparation as
well as errors in training (warm-up, stretching, program progression) are causative factors.
Subjective: Symptoms
Pain in a specific area that persists during and after exercise; history of increased activity in a new program;
or a specific event, such as a long run, which significantly exceeds previous training.
Objective: Signs
Using Basic Tools: Point tenderness with palpation; (i.e., tibial stress fracture most common at junction of
middle and lower thirds or middle and upper thirds of the bone); significant edema in the dorsum of the foot
over metatarsal fracture; compensatory antalgic gait.
Using Advanced Tools: X-rays (if available) Initially normal but repeat study at 3-4 weeks after onset will
often show slight callus formation.
Assessment:
Differential Diagnosis - metatarsal stress fracture: metatarsalgia, Freiberg’s neuroma, capsulitis
Plan:
Treatment
Primary:
- Conservative: Rest until point tenderness subsides; ice and NSAIDs.
- Alternate exercise: Swimming or biking in place of running to maintain cardiovascular fitness. Gradually
resume a running program once pain free. - Identify biomechanical and structural predisposing factors (i.e., tibial varum, cavus foot, flatfoot, long 2nd