diseases/disorders of the bone. common foot disorders hallux valgus hallux valgus hammertoe...

Diseases/Disorders Diseases/Disorders of the Boneof the Bone

Common Foot DisordersCommon Foot Disorders

Hallux valgusHallux valgus HammertoeHammertoe

Hallux ValgusHallux Valgus

BunionBunion Enlargement and lateral displacement of Enlargement and lateral displacement of

great toegreat toe Due to chronic pressure against the great Due to chronic pressure against the great

toetoe HeredityHeredity Pointed-toe shoes or high heelsPointed-toe shoes or high heels Metatarsophalangeal (MTP) joint enlargedMetatarsophalangeal (MTP) joint enlarged Callus developsCallus develops

HammertoeHammertoe

Flexion of the proximal interphalangeal Flexion of the proximal interphalangeal joint with hyperextension of the MTP and joint with hyperextension of the MTP and distal interphalangeal jointsdistal interphalangeal joints

Affects any toeAffects any toe Causes painful corns to developCauses painful corns to develop

Foot DisordersFoot Disorders

Corrective shoes and orthotic devicesCorrective shoes and orthotic devices Analgesics and corticosteroidsAnalgesics and corticosteroids SurgerySurgery Nursing CareNursing Care

PainPain Risk for InfectionRisk for Infection

OsteomalaciaOsteomalacia

Adult ricketsAdult rickets Inadequate mineralization of boneInadequate mineralization of bone Insufficient amounts of calcium or Insufficient amounts of calcium or

phosphatephosphate No mineralization of bone matrixNo mineralization of bone matrix

Bone unable to bear weightBone unable to bear weight Results in deformities and pathologic Results in deformities and pathologic

fracturesfractures Cause is lack of vitamin DCause is lack of vitamin D

Paget’s DiseasePaget’s Disease

Increase of osteoclastsIncrease of osteoclasts Osteoblasts are stimulated but produce Osteoblasts are stimulated but produce

soft and poorly mineralized bonesoft and poorly mineralized bone Prone to fractureProne to fracture Cause unknownCause unknown

Osteomalacia/Paget’s Osteomalacia/Paget’s DiseaseDisease

Replace vitamin DReplace vitamin D Calcium and phosphate supplementsCalcium and phosphate supplements Biphosphonates and calcitonin drugsBiphosphonates and calcitonin drugs

OsteoporosisOsteoporosis

““Porous Bones”Porous Bones” Fragile bones with risk of fracturesFragile bones with risk of fractures 80% are women over the age of 6080% are women over the age of 60 Cause unclearCause unclear

Osteoporosis – Risk FactorsOsteoporosis – Risk Factors

Cannot be ChangedCannot be Changed AgeAge FemaleFemale Family historyFamily history Endocrine Endocrine

disordersdisorders

Can be ChangedCan be Changed Calcium deficiencyCalcium deficiency Estrogen deficiencyEstrogen deficiency SmokingSmoking Excess alcoholExcess alcohol Sedentary lifestyleSedentary lifestyle MedicationsMedications


Reduced bone massReduced bone mass Imbalance of bone growth and Imbalance of bone growth and

maintenancemaintenance Peak bone mass at age 35Peak bone mass at age 35 Formation does not keep pace with Formation does not keep pace with

resorption, resulting in loss of bone massresorption, resulting in loss of bone mass


Type IType I Postmenopausal women ages 51–75Postmenopausal women ages 51–75 Caused by estrogen deficiencyCaused by estrogen deficiency

Type IIType II Men and women over age 70Men and women over age 70 Slow developmentSlow development Calcium deficiencyCalcium deficiency


Focus is on stopping or slowing processFocus is on stopping or slowing process Relieving symptomsRelieving symptoms Preventing complicationsPreventing complications Bone density measurementBone density measurement


CalciumCalcium Vital in preventionVital in prevention Adequate intake may slow processAdequate intake may slow process Calcium needs change over lifetimeCalcium needs change over lifetime NIH calcium intake recommendationsNIH calcium intake recommendations

NIH Recommended Daily Calcium Intake.NIH Recommended Daily Calcium Intake.


MedicationsMedications Calcium supplementsCalcium supplements Hormone replacementHormone replacement Other drugsOther drugs

Osteoporosis – Nursing CareOsteoporosis – Nursing Care

Risk for InjuryRisk for Injury Imbalanced Nutrition: Less than Body Imbalanced Nutrition: Less than Body

RequirementsRequirements PainPain


TeachingTeaching PreventionPrevention Calcium intake in dietCalcium intake in diet Physical activityPhysical activity Hormone replacement therapyHormone replacement therapy SmokingSmoking Fall preventionFall prevention

ArthritisArthritis

Inflammation of a jointInflammation of a joint LocalizedLocalized

OsteoarthritisOsteoarthritis SystemicSystemic

Rheumatoid arthritisRheumatoid arthritis Systemic lupus erythematosusSystemic lupus erythematosus

OsteoarthritisOsteoarthritis

Degenerative joint disease with Degenerative joint disease with progressive loss of joint cartilageprogressive loss of joint cartilage

Most common typeMost common type Leading cause of disability in older adultsLeading cause of disability in older adults Equal in men and womenEqual in men and women


Risk factorsRisk factors AgeAge Repetitive joint use and traumaRepetitive joint use and trauma HeredityHeredity ObesityObesity Congenital and acquired defectsCongenital and acquired defects


Entire joint affectedEntire joint affected Cartilage loses strength and elasticity and Cartilage loses strength and elasticity and

erodes and ulcerateserodes and ulcerates Underlying bone exposedUnderlying bone exposed Cartilage-coated osteophytes (bony Cartilage-coated osteophytes (bony

outgrowths)outgrowths)


Manifestations and complicationsManifestations and complications Inflammation in the jointInflammation in the joint PainPain Decrease in joint range of motionDecrease in joint range of motion Enlarged jointsEnlarged joints Herniated diskHerniated disk


HistoryHistory Physical and x-ray examinationPhysical and x-ray examination Weight reduction and exerciseWeight reduction and exercise Heat for local pain reliefHeat for local pain relief MedicationsMedications SurgerySurgery ArthroscopyArthroscopy

ArthroplastyArthroplasty

Reconstruction or replacement of the Reconstruction or replacement of the jointjoint Total joint replacementTotal joint replacement

Hip, knee, shoulder, elbow, ankle, wrist, Hip, knee, shoulder, elbow, ankle, wrist, joints of finger and toesjoints of finger and toes

Infection is major problemInfection is major problem

Total hip replacement.Total hip replacement.

Total knee replacement.Total knee replacement.

Osteoarthritis – Nursing Osteoarthritis – Nursing CareCare

Assessment focuses on effects of the Assessment focuses on effects of the disease and ADLsdisease and ADLs

Nursing diagnosisNursing diagnosis Chronic PainChronic Pain Impaired Physical MobilityImpaired Physical Mobility Self-Care DeficitSelf-Care Deficit

Osteoarthritis – Nursing Osteoarthritis – Nursing CareCare

TeachingTeaching Environmental safetyEnvironmental safety Use of assistive devices to maintain Use of assistive devices to maintain

independenceindependence MedicationsMedications Activity and weight bearingActivity and weight bearing Signs and symptoms of infectionSigns and symptoms of infection

Rheumatoid ArthritisRheumatoid Arthritis

Chronic systemic inflammatory disorder of Chronic systemic inflammatory disorder of the jointsthe joints

More women than menMore women than men Ages 30–50Ages 30–50 Multiple jointsMultiple joints Remission and exacerbationsRemission and exacerbations


Autoimmune responseAutoimmune response Autoantibodies (rheumatoid factors) bind Autoantibodies (rheumatoid factors) bind

with IgG to form immune complexeswith IgG to form immune complexes Complement activated and WBCs Complement activated and WBCs

attracted to the areaattracted to the area Cells phagocytize immune complexes and Cells phagocytize immune complexes and

also destroy the jointalso destroy the joint

Joint inflammation and destruction in rheumatoid arthritis.Joint inflammation and destruction in rheumatoid arthritis.


Systemic symptomsSystemic symptoms FatigueFatigue AnorexiaAnorexia Weight lossWeight loss Aching and stiffnessAching and stiffness

Destruction of joints and immobilityDestruction of joints and immobility

Typical hand deformities associated with rheumatoid arthritis. (Typical hand deformities associated with rheumatoid arthritis. (Source:Source: Custom Medical Stock Photos, Custom Medical Stock Photos, Inc.)Inc.)


DiagnosisDiagnosis History and physical examHistory and physical exam Rheumatoid factorsRheumatoid factors Erythrocyte sedimentation rateErythrocyte sedimentation rate Synovial fluid aspirateSynovial fluid aspirate X-raysX-rays

Rest and exerciseRest and exercise

Rheumatoid Arthritis - Rheumatoid Arthritis - TreatmentTreatment

MedicationsMedications Aspirin and NSAIDsAspirin and NSAIDs SteroidsSteroids Drugs to modify the autoimmune responseDrugs to modify the autoimmune response

SurgerySurgery Relieve pain and repair or replace jointsRelieve pain and repair or replace joints Arthrodesis (joint fusion)Arthrodesis (joint fusion)

Rheumatoid Arthritis - Rheumatoid Arthritis - TreatmentTreatment

PlasmapheresisPlasmapheresis Total lympoid radiationTotal lympoid radiation

Rheumatoid Arthritis – Rheumatoid Arthritis – Nursing CareNursing Care

Assessment focuses on progress of Assessment focuses on progress of disease and effect on functional abilitiesdisease and effect on functional abilities

Nursing diagnosesNursing diagnoses PainPain FatigueFatigue Ineffective Role PerformanceIneffective Role Performance Disturbed Body ImageDisturbed Body Image

Rheumatoid Arthritis – Rheumatoid Arthritis – Nursing CareNursing Care

TeachingTeaching Disease and systemic effectsDisease and systemic effects Rest and exerciseRest and exercise MedicationsMedications Assistive devicesAssistive devices SafetySafety

OsteomyelitisOsteomyelitis

Infection in the boneInfection in the bone Staphylococcus aureusStaphylococcus aureus Any ageAny age Older adults at riskOlder adults at risk Pathogens enter the bone from an open woundPathogens enter the bone from an open wound Spread to the bone from local tissueSpread to the bone from local tissue


Pathogens lodge and multiplyPathogens lodge and multiply Cause inflammatory and immune system Cause inflammatory and immune system

responseresponse Phagocytes attempt to contain the infection, Phagocytes attempt to contain the infection,

but release enzymes that destroy bone tissuebut release enzymes that destroy bone tissue Canals in the marrow cavity of the bone allow Canals in the marrow cavity of the bone allow

the infection to spreadthe infection to spread Spreads along the surfaceSpreads along the surface Disruption of blood supply leads to necrosisDisruption of blood supply leads to necrosis


Early diagnosis and antibiotic therapyEarly diagnosis and antibiotic therapy WBCWBC Blood and tissue culturesBlood and tissue cultures MRIMRI Bone scanBone scan

Medications intravenouslyMedications intravenously SurgerySurgery

CulturesCultures DebridementDebridement

Osteomyelitis – Nursing Osteomyelitis – Nursing CareCare

PainPain HyperthermiaHyperthermia Impaired Physical MobilityImpaired Physical Mobility TeachingTeaching

Medications and wound managementMedications and wound management Rest and limited weight bearingRest and limited weight bearing Good nutritionGood nutrition

diseases/disorders of the bone. common foot disorders hallux valgus hallux valgus hammertoe...

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bone slide

loss of bone mass slide

weight bone unable

mineralized bone prone

mineralized bone osteoblasts

infection slide

maintenance peak bone

loss of bone mass formation