Progress Notes
Subjective
tjr, a(n) 83 y.o. man, returns to clinic for fungal nails and calluses. Continues to use ciclopirox. Interested in any other additional treatments for fungal nails. Left 5 nail somewhat painful.
PMH
New diagnosis of osteoporosis and started on Fosamax
ROS
In usual state of health
Objective
LOWER EXTREMITY EXAM
Vascular
- Bilateral DP/PT pulses palpable
- Feet are warm bilateral
- CFT > 3 seconds, 1-10
- Digital hair present bilateral
- Edema: bilateral edema
- Erythema: left medial foot
- Varicose or spider veins to the legs and ankles: absent bilateral
Dermatological
- Nail(s) thick, dystorophic with subungual debris: left 5th, left 4th, 40% clear and right hallux 5-6 mm clear
- Scaling and peeling of skin: absent bilateral
- Pigmentary changes: none
- Hyperkeratoses: right hallux distal medial, left hallux laterally
- No rashes
- No webspace maceration or erythema
- Prior wound locations: distal tips of right 4th and 5th toes
Neurological
- Coordination: normal heel-to-toe gait
- Sharp/dull: normal bilateral
- Sensation intact to light touch bilateral
Musculoskeletal
- Mild tenderness to palpation to left 5th toenail
- No tenderness to palpation to ankle joint, lateral or medial ligaments, Achilles tendon, Achilles insertion, plantar medial calcaneal tubercle, central plantar fascia, navicular tuberosity, TP tendon, styloid process or personeal tendons.
- Bony prominence(s): none
- Digital deformities: none
- Windlass mechanism intact bilateral
- STJ: supple and pain free, reducible to neutral bilateral
Assessment/Plan
Onychomycosis
Callus
- Debrided nails 1-10 and callus to tolerance without incident
- Continue using ciclopirox daily
- Completed a course of oral terbinafine in 2022 without much improvement
- Will continue regular debridement for symptomatic relief
- Discussed possible new light based antifungal therapy to be offered in office; patient interested and would like to be notified
Next appointment: 3 months