M

M


maceration increase in bulk (with softening) of the stratum corneum; caused by prolonged exposure to sweat or induced by topical application of hydrolysing or caustic chemicals, in treatment of verrucae or corn


macrocirculation circulation of blood through larger vessels (arteries and veins) – see microcirculation


macrocyte; megaloblast abnormal, large erythrocyte characteristic of pernicious anaemia


macroglossia tongue enlargement, as in hypothyroidism


macrolides class of antibiotic with similar activity to penicillin, e.g. erythromycin, clarithromycin


macromelia abnormal enlargement of one limb; rare cause of leg length discrepancy


macromolecule large molecule, e.g. a protein, globulin, nucleic acid or polysaccharide


macroonychia see onych-


macrophage large, mononuclear, amoeboid phagocytic and multifunctional cell; has a major role in inflammation and tissue repair (identifies and engulfs dead/damaged cells, destroys microorganisms, synthesizes and releases chemical mediators of inflammation, initiates immune response to invading microorganisms, initiates tissue regeneration [releases growth factors and chemoattractants for fibroblasts] involved in tissue repair)


macroscopic visible to the naked eye


macrovascular disease see atherosclerosis


macula small, sessile, discoloured skin patch


macula lutea oval area of retina adjacent to optic disc


maculopapule broad-based, sessile skin lesion with central raised papule


maculopathy any pathological condition of macula lutea; e.g. diabetic retinal disease


Madura foot tropical deep infection (e.g. of a penetrating wound) with Madurella fungus, characterized by necrosis, chronic pus and sinus formation, and gross foot swelling


maggot therapy see larval therapy


magnesium sulphate see Epsom salts


magnetic resonance imaging scan; MRI scan non-ionizing imaging modality; body part under investigation is subjected to electromagnetic pulses (hydrogen ions and protons align and emit detectable radio waves), building a tissue ‘picture’ in 3- or 5-mm-wide sections




Magnetopulse device generating a pulsed magnetic field within targeted tissues; used to gain symptomatic relief of injury and inflammation, or to increase blood flow to specific tissue areas (Table M1); contraindicated in diabetes, pacemakers, pregnancy or history of thrombosis



‘major tranquillizers’ see neuroleptics


-malacia softening/loss of tissue consistency/contiguity, e.g. osteomalacia; chondromalacia


malalignment injury foot, lower-limb or back injury due to positional compensation, e.g. excessive foot pronation, tibial varum, genu valgum, degenerative joint disease or structural anomaly


malar rash butterfly rash or facial vasculitis characteristic of autoimmune disease, e.g. systemic lupus erythematosus


Malassezia furfur causative fungal organism of pityriasis versicolor (tinea versicolor), see pityriasis versicolor


malathion topical treatment for ectoparasite infection (e.g. scabies, head and body lice [crabs])


malformation failure of normal development


malignant locally invasive, destructive, neoplastic growth; can undergo metastasis


malignant melanoma see melanoma


malleolar arteries anterior tibial artery branches forming medial and lateral malleolar arteries (latter anastomoses with perforating branch of peroneal artery)


malleoli (singular: malleolus) rounded bony process at distal end of leg, marking medial and lateral ankle joint borders




mallet toesee toes Table L1


mal perforans neuropathic perforating (trophic) ulcer, with exposure of deep structures (plantar fascia, tendons, joint ligaments or bone); often complicated by deep soft-tissue and bone infection


malpighian body tuft of capillary loops within and surrounding Bowman’s capsule that together form the beginning of a renal nephron


malunion incomplete/misaligned post-injury bone union


management plan; MP proposed and written course of short-term and long-term treatment regimes linking the patient examination and diagnosis to resolution of patient’s presenting condition; should be agreed by both practitioner and patient, and include an outline of all treatments likely to be included, estimates of treatment success rates, likelihood of recurrence of condition and/or need for further or ongoing treatments, and the frequency of those treatments; it should also note any items of (written) information or verbal advice given to the patient, specify any discipline to whom patient should be referred, and also detail any treatment area to be undertaken by the patient him- or herself; therapies indicated in the MP plan should be supported by evidence-based medicine, local protocols, treatment algorithms and similar; MP is retained in patient notes, copied to referring practitioner, reviewed regularly (e.g. after specified number of visits) and a list of the range of other possible options recorded if initial interventions are unsuccessful or problem recurs (e.g. referral to another specific discipline for a named form of therapy/advice) (Table M2)


Table M2 Example of a management plan for a child with nail pain


















Feature Detail/explanation
Main presenting complaint 9-year-old girl presents with 3-week history consisting of pain in the medial (tibial) sulcus of the left hallux since ‘picking’ nail
Otherwise fit (i.e. no other significant medical history; no regular medications)
Advised to contact you by GP
Examination Local tenderness, inflammation and swelling at medial area of left hallux; no signs of obvious infection; medial side of nail plate very ragged as a result of onychotillomania
Vascular examination: normal
Neurological examination: normal
Dermatological examination: mild hyperhidrosis in both feet
Biomechanical assessment: fully compensated rearfoot varus; no joint pathologies
Social assessment: dance and gymnastics twice a week
Footwear assessment: trainers (one size too small); laces not tied
Diagnostic tests None indicated
Management plan Short-term plan
Explanation of likely cause of current problem (picking nails, hyperhidrotic skin, short, unlaced shoes, excess pronation)
1. Immediate treatment: exploration of both sides of both first toenails, and reduction of ragged edges with Black’s file + LA is necessary, with patient/parental consent. Advise regime of daily warm saline foot baths and demonstration to mother on how to pack affected sulcus with cotton wool. Review in 7 days (or SOS)
2. Advice
Exercise advice: no gym/sport/dance before next appointment
Shoe advice (give leaflet) – needs a larger trainer, and needs to tie laces so that rearfoot is retained in the heel cup of the shoe
Skin care advice (treatment/avoidance of hyperhidrosis) – give leaflet
3. Temporary insole with medial felt (cobra) pad to minimize hallux trauma due to excess compensatory pronation/foot lengthening on weight-bearing
4. Letter to GP informing of action to date (copy to notes)
Long-term plan
Explanation of details of other treatments that may be necessary after next visit
1. Further clearance of medial side of first nail or removal of spike of nail under LA or removal of medial section of first nail under LA and phenolization of exposed pocket of nail matrix + dressings (94% cure rate) + details of aftercare regimes for this range of options
2. Biomechanical and gait evaluation, with provision of bespoke antipronatory orthoses
3. Review patient every 4 months to monitor biomechanical, skin and nail function

LA, local anaesthetic.


Manchester Foot Pain and Disability Questionnaire (MFPDQ) validated, foot-specific outcomes measure, used to assess impact of rheumatoid disease and other painful foot conditions


manic–depressive psychosis; bipolar disorder major, often remissive/recurrent mental illness, characterized by severe mood changes


manoeuvre planned movement




Manusept see triclosan


march fracture see fracture, march


Marfan’s syndrome see syndrome, Marfan’s


Marjolin’s ulcer see ulcer, Marjolin’s


marrow soft, fatty, haemopoietic tissue within medullary cavity of long bones


mask (1) device covering nose and mouth, facilitating administration of mouth-to-mouth assisted respiration (e.g. Leyerdahl mask), as part of infection control protocol, or to prevent inhalation of particulate matter


mask (2) several layers of adhesive strapping (with a central hole, matching lesion size); protects surrounding skin from effects of ointment-based caustic agents applied to e.g. verrucae; Figure M1



mass amount of matter contained by an object


matrix tissue formative element





mattress sutures interrupted sutures that cause minimal tension at wound edges; see Figure H4; Table S6


maturity-onset diabetes mellitus outdated term for type 2 diabetes mellitus


maturity-onset diabetes of the young; MODY presentation of type 2 diabetes mellitus affecting overweight young adults or teenagers, similar to type 2 diabetes of older subjects, but usually without secondary complications (see also diabetes mellitus and type 2 diabetes mellitus)


maximum safe dose; MSD body mass-related maximum dose (of a pharmacological agent) that can be administered within a 24-hour period, usually quoted for a 70-kg adult; calculated as the product of body mass and the amount or percentage mass of drug used (Tables M3-M5); MSD cannot be increased in a patient weighing >70 kg, and must be reduced proportionally for patients weighing <70 kg, or with reduced liver/kidney function, or concurrently using e.g. beta-blockers, antiarrhythmic drugs or central nervous system-acting drugs (Table M3)


Table M3 Maximum safe doses of plain local anaesthetic agents (for 70 Kg adult in 24 hours)































Agent (brand name) Maximum safe dose (70-kg adult) Dose per kg of body mass
Lidocaine (Xylocaine) 200 mg 3 mg/kg
Bupivacaine (Marcain) 150 mg 2 mg/kg
Levo-bupivacaine (Chirocaine) 150 mg 2 mg/kg
Mepivacaine (Scandonest) 400 mg 6 mg/kg
Prilocaine (Citanest) 400 mg 6 mg/kg
Ropivacaine (Naropin) 250 mg 3.5 mg/kg



Mayo block; first-ray block see anaesthesia, first-ray block


mean measure of central tendency; average value (i.e. sum of all values divided by number in sample); mean, median and mode are identical in normally distributed data


mean cell volume; MCV mean erythrocyte volume; calculated from the haematocrit and red cell count


measurements objective and numerical records, i.e. signs, questionnaire-derived data, body part dimensions (e.g. leg length, shoe size, available subtalar joint inversion)


mechanics study of forces acting on objects, and effects induced by the application of force (e.g. movement, size, shape and structural effects)


mechanobullous skin disorders skin diseases characterized by epidermis or dermis fragility, or fragility of adhesion mechanism of epidermis on dermis, e.g. epidermolysis bullosa


mechanoreceptors specialized sensory nerve endings at termini of A-beta nerve fibres; preferentially subserve mechanosensation, e.g. touch, vibration (see Table S2)


medial ankle ligament see deltoid ligament; Table A7


medial arterial calcification; MAC see Mönckeberg’s sclerosis


medial collateral ligament of 1 MTPJ capsular thickening at medial aspect of first metatarsophalangeal joint (1 MTPJ), forming medial aspect of 1 MTPJ ‘socket’; blends with medial sesamoid ligament


medial column sagittal subdivision of the foot; formed of navicular, medial, intermediate and lateral cuneiforms, first, second and third metatarsals and their respective phalanges; articulates with hindfoot at talonavicular joint (i.e. midtarsal joint)


medial dorsal cutaneous nerve terminal branch of superficial peroneal nerve; innervates medial aspect of first ray and second intermetatarsal space; may become compressed (entrapped) at first metatarsal–medial cuneiform joint area, causing dermatomal distal paraesthesia and pain (see intermediate dorsal cutaneous nerve)


medial dorsal cutaneous nerve block see anaesthesia, superficial peroneal


medial eminence bony exuberance, frequently overlain by adventitious bursa, at medial aspect of first metatarsal head; characteristic of a bunion


medial flange see valgus pad


medial forefoot wedge wedge of material (clinical padding or orthosis) that fills the potential space between medial plantar forefoot and underlying support surface, and resists compensatory forefoot pronation; terminal part of medial sole wedge (see cobra pad)


medial gutter soft-tissue space between medial articular surface of talus and lateral articular surface of tibial malleolus


medial knee pain pain and discomfort at medial knee joint area, secondary to strain imposed by excess foot pronation (see Table K3)


medial longitudinal arch; MLA D-shaped concavity (in frontal and sagittal planes), at middle one-third of medial plantar aspect of foot; extends from distal limit of heel to just proximal to head of first metatarsal, and from medial (inner) border of foot to just medial to plantar cuboid (see Figure C3, Table A7)


medial longitudinal arch height sagittal-plane height of medial longitudinal arch is determined by calcaneal angle of inclination, talar pitch and first metatarsal angle of declination; the navicular functions as the arch ‘keystone’ (see Figure C3)


medial plantar artery terminal branch of posterior tibial artery, supplies medial aspect of hallux; anastomoses with first plantar metatarsal artery


medial plantar nerve medial division of terminal branches of tibial nerve; subserves medial plantar area, except medial area of medial longitudinal arch and plantar surface of heel (see Figure D1)


medial sole wedges see cobra pad


medial support strapping soft splint formed from 2.5-cm-wide elastic strapping, applied as a ‘stirrup’ to hind- and midfoot (with foot held in inversion; ± valgus filler pad) as short-term management of chronic medial ankle pain/trauma, or chronic plantar fasciitis (Figure M2)



medial (tibial) sesamoid ligament ligament suspending medial side of medial sesamoid; blends with medial collateral ligament of first metatarsophalangeal joint


medial tibial stress syndrome; MTSS see syndrome, medial tibial stress (Tables M6 and M7)


Table M6 Grades and characteristics of medial tibial stress syndrome (MTSS)


















Grade Characteristic
1 Pain on palpation of the anteromedial (or posteromedial) area of tibial crest
No pain during activity or exercise
2 Pain after activity or exercise
No pain during activity or exercise
3 Pain during activity or exercise
Pain after activity or exercise
4 Pain and discomfort during normal walking
Continual pain during activity or exercise

Table M7 Phased treatment approach to medial tibial stress syndrome (MTSS)


















Presentation Treatment
Phase 1: acute phase Cessation of exercise activity until all pain resolves RICE(P)
Phase 2: rehabilitation phase Deep compartment muscle exercise to strengthen the deep fascial–bone interface and reduce tension on the deep fascial insertion, in order to decrease pain and swelling and prevent fascial scarring
Phase 3: functional phase Use of antipronatory/functional orthoses, strapping or taping in order to strengthen the fascial–bone interphase and prevent further excessive tension on the tibia
Phase 4: return to activity Phased and gradual return to normal levels of activity

median middle value in range of measurements; mean, median and mode are identical in normally distributed data


median line of foot imaginary line bisecting foot longitudinally, from central heel to second/third webspace


median plane see cardinal planes of the body


Medical Devices Agency; MDA UK competent authority for manufacture of medical devices (e.g. bespoke orthoses); EEC Directive 93/42 requires that all manufacturers are registered with the MDA, and that all manufactured orthoses carry the CE mark (see Box C1)


medical emergencies unexpected clinical emergencies arising as a result of, or during, treatment (Table M8)


Table M8 Actions to minimize the incidence of medical and clinical emergencies















Clinical event Example actions to minimize the incidence of clinical emergency event
Pretreatment patient screening Knowledge of patient’s current medical history
• Cardiovascular pathology
• Respiratory disease
• Renal problems
• Endocrine disease
• Current medications regime
• Social history (cigarette smoking; alcohol)
Resuscitation In-clinic availability of:
• Oxygen
• Portable defibrillator
• Injectable adrenaline
Clinician training
• Basic life support
• Immediate life support
• Advanced life support
Intraoperative monitoring Staff team training
• Designated roles to be taken in the event of clinical emergency
Recognition of incident emergencies and actions protocols
• Cardiac arrest
• Vasovagal attack/faint
• Anaphylaxis
• Hypoglycaemia
• Local anaesthetic overdose
• Hypovolaemia

Medical Exposures Directive Council Directive 97/43/Euratom of 30 June 1997; revoked 1988 Ionizing Radiation Regulations


medical history information given by patient (and/or patient’s partner/carer/parent/referring practitioner), detailing the patient’s current and past health status (Table M9)


Table M9 The medical history






































History element Additional information
Introductory information Demographics (age, sex, race, place of birth, marital status, occupation, religion, next of kin)
Main presenting complaint The problem that has prompted the patient to request the consultation (and/or additional information supplied by referrer)
Past history
Medical General state of health, childhood illnesses, adult illnesses, psychiatric illnesses, accidents and injuries, operations and hospitalizations (list surgical procedures in chronological order)
Podiatric Previous foot/limb problems and treatments received
Current health status Current GP or hospital clinics attended
Current allied health professional clinics attended
Alternative therapists attended
Drugs/medications history Current and previous prescription-only medicine regimes
Current and recent over-the-counter regimes
Allergies and hypersensitivity history
Family history Health and age of siblings/parents/children
Ages and causes of death of parents/grandparents
Social history Smoking/alcohol/recreational drug consumption
Hobbies and recreational activities
General systems review: CRANGLES C = cardiovascular system (e.g. history of heart problems, high blood pressure, previous rheumatic fever, heart murmurs, arrhythmias/palpitation, chest pain/angina, blood dyscrasias, peripheral arterial disease [intermittent claudication, leg cramps, rest pain], venous incompetence, lymphatic dysfunction)
R = respiratory system (e.g. history of asthma, bronchitis, emphysema, tuberculosis)
A = alimentary system (e.g. history of weight change, indigestion, gastric/duodenal ulcer, liver or gallbladder problems, irritable bowel, constipation)
N = central and peripheral nervous system (e.g. history of stroke, nerve injury, any psychiatric problems, fatigue and sleep alteration)
G = genitourinary system (e.g. polyuria, nocturia, pain on urination)
L = locomotor (musculoskeletal) system (e.g. joint or muscle pain, morning stiffness, arthritis, gout, lower-back pain)
E = endocrine system
S = skin (rashes, lumps, sores, itching, dryness, colour changes, changes in hair/nails/sweat pattern)
Foot and lower-limb systems review Vascular review (arteries, veins, lymphatics)
Neurological review (sensory, motor, autonomic)
Biomechanical review
Dermatological review
Overall impression of status of tissues of the foot and lower limb

medicine treatment of disease








Medicines and Healthcare products Regulatory Agency (MHRA) UK authority governing access to provision and use of medicines and health care products


medicolegal legal requirements inherent within practice of podiatry


mediolateral oblique projection see Table R1


medulla oblongata lowest subdivision within brainstem, continuous with spinal cord; extends from decussation of pyramids to pons


mefenamic acid; Ponstan non-steroidal anti-inflammatory drug indicated for mild/moderate pain relief in rheumatoid arthritis, osteoarthritis and postoperative analgesia


megakaryocyte large nucleated cell within bone marrow (but not circulating blood), fragments of which form platelets


megaloblast see macrocyte


meiosis reduction division; see chromosomes


Meissner corpuscles specialized endings at A-beta sensory nerves; lie within upper poles of dermal papillae; subserve light touch skin sensation Table S2


Melaleuca alternifolia tea tree bush


melalgia claudicating pain extending from feet into legs, characteristic of arterial wall hypertrophy/vessel lumen obliteration


melanin dark brown/black pigment within melanosomes of epidermal melanocytes (see melanosome)


melanocytes neural tube-derived, melanin-producing cells of dermoepidermal junction and stratum germinativum; characterized by long branching dendritic processes (see melanosome)


melanoma malignant neoplasm of melanocytes; capable of widespread metastasis (see Table C13)


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