Special Operations Forces Medical Handbook

5-4

Assessment:
Differential Diagnosis: Corn, callus, pyogenic granuloma, other lesions. See Podiatry: Corns and
Callus.
A wart may bleed (pinpoint) with debridement but callus will not. Pyogenic granuloma bleeds easily.

Plan:
Treatment
Primary:

1. Debride overlying callus with #15 or 10 blade to allow medicine to reach wart. See video on CD-ROM


2. Apply aperture pad to keep topical preparation isolated over the wart. 1/8“ felt padding with sticky back
   works well. Pre-cut felt pads are available, but if material is in sheets, cut and size to fit. Moleskin
   okay to cover but it will not relieve the load a tender area. The padding and aperture prevents adjacent
   skin irritation.


3. Apply 60% salicylic acid paste (or monochloroacetic acid) to wart. Tape to cover and hold in place
   for 3 days.


4. Repeat treatment in one week.


5. Surgical curettage should be reserved for unresponsive cases and is not recommended in the field.
   Curettage reduces the chance of plantar scarring since the procedure does not involve penetration below
   the dermis when done correctly.


6. A surgical excision of a wart using two semi-elliptical incisions is a consideration for a wart in a non-weight
   bearing area. Surgical excision should never be performed on weight bearing areas because of the risk of
   scarring and subsequent pain with ambulation.
   Alternative: Liquid nitrogen (LN 2 ), trichloroacetic acid, many over-the-counter preparations.
   Primitive: Pad around wart to increase comfort in the field. Hold other treatment if short-term mission.

Patient Education
General: The cause of the wart is a virus. Topical re-treatment may be required. Discontinue treatment for a
few days if the area becomes too sore and painful. Also discontinue if the area becomes infected.
Medications: Use over-the-counter anti-inflammatories if pain significant.
Prevention and Hygiene: Use deck shoes or sandals in shower/pool areas to prevent spread among
troops.

Follow-up Actions
Return evaluation: Follow up weekly until resolved
Evacuation/Consultation Criteria: Evacuation not normally necessary. Consult podiatry or dermatology
for resistant cases.

Podiatry: Bunion (Hallux Abductor Valgus)

CDR Raymond Fritz, MSC, USNR

Introduction: A bunion is an enlargement at the 1st metatarsal head of the great toe, which deviates
laterally. Often there is no bump, but rather an angulation of the first metatarsal (hallux abductor valgus)
that makes the head of this bone more prominent. Genetic factors, foot mechanics and poorly fitting or
excessively worn shoes are commonly blamed for the development of both deformities. Pain is a result of
cartilage erosion, bursitis and neuritis in the effected joints.

Subjective: Symptoms
Pain near first metatarsal head, history of a progressive deformity over time.

Objective: Signs
Using Basic Tools: Bump, erythema and tenderness medially (tibial aspect) over the first metatarsal head;
joint stiffness in more chronic cases, especially with excessive pronation (flat feet).
Using Advanced Tools: X-rays are helpful in evaluating angular relationships and joint integrity when