Onychomycosis, routine callus care, diabetic foot examination in the outpatient setting and update on prescription foot orthoses

Purpose of review: To present recent concepts and ideas about the diagnosis and management for onychomycosis, routine callus care, diabetic examination of the foot and an update on prescription foot orthoses. Also described are the stages of onychomycosis and the risk factor associated with onychomycosis. The current management of onychomycosis in nonimmunocompromised and immunocompromised individuals is reviewed. There were few recent publications on the diabetic foot examination in the outpatient setting, callus care and prescription foot orthoses. This format will be used to briefly review current practices in diabetic foot examination, callus care and prescription orthoses. Recent findings: The literature supports the use of the periodic acid-Schiff stain as the single most diagnostic method of choice for onychomycosis. Recent findings show that testing with a 4.5-g monofilament under bilateral plantar first metatarsal heads could save time. Testing of those two sites provided comparable or better performance at high levels. Summary: In regards to onychomycosis, physicians should consider starting a maintenance regimen with a topical antifungal during or after treatment with an oral antifungal. Combination therapies for severe onychomycosis should be considered a reasonable treatment course. Terbinafine is still considered superior to other oral antifungal therapies. Diabetic foot examination for sensory perception may take less time to complete. There have not been any significant changes in routine calius care and prescription orthoses.