P

pacemaker see artificial pacemaker

pachyonychia congenita rare, congenital, autosomal-dominant disease characterized by generalized skin thickening and anhidrosis, and marked onychogryphosis of toenails and fingernails developing during babyhood

pacinian corpuscles specialized nerve endings subserving vibrational awareness, located deep within dermis; formed as lamellated bulbs at termini of A-beta sensory nerve fibres (see Table S2)

packed cell volume (postcentrifuge) volume of blood cells in a sample of blood

packing infilling a wound with dressing material

pad see individually named pads; Table P1 and Figure P1

Table P1 Examples of clinical pads

padding materials clinical materials used specifically to cushion, deflect pressure from or protect an area, substitute for lost tissue; adhesive padding materials include felts, polyurethane and polyethylene sheet foam and fleecy web that are shaped and stuck directly to skin, added to insoles or added to the shoe inner (see individually named pads Tables P1 and P2 and Box P1)

Table P2 Functions of clinical padding materials

Paget’s disease see disease, Paget’s

pain unpleasant sensory and emotional experience associated with, or described in terms of, actual or potential tissue damage, due to a complex interaction of sensory, emotional and behavioural factors; pain may be acute or chronic, somatic, visceral or neurogenic; it characterizes inflammation

pain control therapeutic measures used to reduce or resolve all components of pain, including analgesic drugs (e.g. paracetamol, non-steroidal anti-inflammatory drugs [NSAIDs], disease-modifying antirheumatic drugs [DMARDs], opioids and anxiolytics), electrical stimulation of the inhibitory control mechanisms (e.g. transcutaneous electrical nerve stimulation [TENS]), hypnosis and other cognitive and behavioural approaches (Table P3)

Table P3 Principles of pain management

pain scale an objective value of subjective pain; value (between 0 and 10) is ascribed by the patient to the pain experience, where 0 = no pain at all, and 10 = worst pain experienced/imaginable; used to note pain in relation to daily activities, or document pain changes over a period of time (e.g. a week or month) in relation to a specific therapeutic interventions

Figure P1a Pads. A, combined dorsoplantar splint. B, adapted combined dorsoplantar splint to obtain deflection from dorsal and apical lesions. C, bolster pad for digits 2–4 when correction cannot be achieved. The bolster deflects pressure away from the apices. This article was published in Neale’s Disorders of the Foot, Lorimer, French, O’Donnell, Burrow, Wall, Copyright Elsevier, (2006).

Figure P1b Pads. A, Metatarsal bar. B, Shaped metatarsal bar. This article was published in Neale’s Disorders of the Foot, Lorimer, French, O’Donnell, Burrow, Wall, Copyright Elsevier, (2006).

Figure P1c Single-digit padding. A, oval cavity pad. B, crescent pad. C, U pad. D, single prop. This padding is generally used to protect a lesion. This article was published in Neale’s Disorders of the Foot, Lorimer, French, O’Donnell, Burrow, Wall, Copyright Elsevier, (2006).

Figure P1d Strapping for plantar metatarsal padding. This article was published in Neale’s Disorders of the Foot, Lorimer, French, O’Donnell, Burrow, Wall, Copyright Elsevier, (2006).

Figure P1e Plantar metatarsal padding (PMP). A, single-wing PMP to the fifth metatarsal head. B, Double-wing PMP to the first and fifth metatarsal heads. C, Ple (C) U’d PMP (to 2MTPJ). This article was published in Neale’s Disorders of the Foot, Lorimer, French, O’Donnell, Burrow, Wall, Copyright Elsevier, (2006).

Figure P1f Shaft pads. A, Long-shaft pad to the first metatarsal and proximal phalanx. B, Shaft pad to the first metatarsal. C, Shaft pad proximal to IMTPJ. This article was published in Neale’s Disorders of the Foot, Lorimer, French, O’Donnell, Burrow, Wall, Copyright Elsevier, (2006).

pain sensation evaluation see Table M13

painful heel see heel pain; Table H9

painful neuropathy presentation of sensory neuropathy predominantly affecting patients with diabetes, affecting one or both feet or legs, in a general or patchy distribution, variably as constant burning sensations, paraesthesiae, ‘crawling’ or shooting pains, or exquisite contact discomfort; affected patients may lose weight, and develop motor neuropathy (proximal diabetic myotrophy); persists for ~ 6–18 months, and heralds profound sensory loss; may respond to mild antidepressant agents (e.g. amitriptyline and diazepam) and anticonvulsant drugs (e.g. gabapentin), but is resistant to normal analgesics

painless painful foot presentation of painful sensory neuropathy in diabetes mellitus; patient reports ongoing, and often severe, foot pain, but demonstrates loss of all sensory modalities

palindromic relapsing; recurring

palliation; palliative therapies that reduce symptom severity, but do not cure

palmoplantar keratoderma; PPK rare, inherited group of skin diseases characterized by altered keratin formation; presents variably as diffuse, focal or punctate palmar and plantar hyperkeratosis, e.g. of weight-bearing skin; severe forms are associated with constricting digital bands, leading to autoamputation; treated by regular hyperkeratosis reduction, keratolytic ointments (e.g. 5–10% salicylic acid in white soft paraffin) and oral retinoids (i.e. vitamin A-derivative) drugs

palmoplantar pustular psoriasis; PPP chronic inflammatory disorder of palms and soles, presenting as red, scaly, hyperkeratotic areas of skin studded with sterile pustules (initially yellow, fading over time to form dark brown scales); tends to affect middle-aged, cigarette-smoking women who may or may not show other signs of psoriasis; treated with emollients and keratolytics (e.g. 5% salicylic acid ointment, to reduce scaling), vitamin D cream, topical 1% steroid cream, coal tar preparations, dithranol and retinoids

palpation examination using the hands, e.g. to outline underlying muscular, vascular or neural structures, determine joint mobility and tissue resistance palpate masses

panarthritis inflammation affecting all joints

pancytopenia marked reduction in numbers of circulating blood cells

pandemic widespread epidemic

panhypopituitarism reduced or inadequate secretion of anterior pituitary hormones, due to pituitary destruction (e.g. secondary to local benign tumour)

panniculitis inflammation of the forefoot plantar fibrofat pad

pannus chronic inflammatory hyperplasia of synovial membrane of joints affected by rheumatoid arthritis; characterized by granulation tissue (infiltrated by inflammatory cells and releasing lytic enzymes) that intrudes into the affected joint space, eroding bone margins and articular cartilage

papilla see tactile papilla

papilloma benign epithelial neoplasm

Papillomavirus genus of DNA-containing oncogenic viruses that replicate within nuclei of infected cells; cause warts and verrucae

papule small, solid, circumscribed, elevated skin lesion

paracetamol see acetaminophen; Table P3

paracoccidioidomycosis tropical fungal infection common in Central America; may cause painful, nodular, haemorrhagic ulcerated and verrucous foot lesions

paraesthesia abnormal sensation, e.g. burning, tingling, pricking; i.e. ‘pins and needles’

paraffin gauze; tulle gras low-adherence gauze or mesh dressing, impregnated with paraffin wax; may also incorporate an antiseptic (e.g. chlorhexidine gluconate) (see Table D10)

paraffin wax baths see wax baths

parallel pitch lines parallel lines drawn on a lateral radiograph of rearfoot, to determine the degree of prominence of posterosuperior eminence of calcaneum (see Table R3; Figure P2)

paralysis; palsy loss of voluntary movement due to muscle injury, neuromuscular pathology, loss of blood supply to subserving motor nerve, or motor nerve dysfunction

parametric tests statistical tests, e.g. t-tests or analysis of variance (ANOVA) that analyse for difference between groups of normally distributed data

paraparesis mild paralysis of legs and feet

paraplegia paralysis of lower trunk and both legs

parasympathetic relating to the parasympathetic division of the autonomic nervous system

parasympathetic nervous system; parasympathetic (craniocaudal) division of the autonomic nervous system cell bodies of motor nerves located within the medulla oblongata and intermediate columns of spinal cord (i.e. at cranial nerves III, VII, IX and X and S2–S4 levels); preganglionic parasympathetic synapses use acetylcholine as neurotransmitter; postganglionic fibres use adrenaline as neurotransmitter

parasympathomimetic an agent whose action causes effects resembling parasympathetic activity

parathormone; PTH hormone released by parathyroid glands; low levels of blood calcium stimulate release of PTH; raised levels of circulating PTH levels stimulate osteoclast activity (releasing calcium from bone) and reduce renal excretion of calcium; PTH action is countered by calcitonin (released by thyroid parafollicular cells)

parathyroid gland see gland, parathyroid

parenchyma cells characteristic of an organ, contained within and supported by the stroma

parenteral administration of a medicinal or therapeutic substance, other than through the gastrointestinal or respiratory tracts, e.g. by intravenous, intramuscular or subcuticular injection

Figure P2b Parallel pitch lines (PPLs) to determine the prominence of the bursal projection (BP or posterosuperior prominence). PPL₁ is the baseline, tangential line to A anterior tubercle, and M medial tubercle of posterior tuberosity; the perpendicular d is drawn between between PPL₁ and T posterior lip of talar articular facet. The bursal projection BP touching or below PPL₂ is normal, not prominent. This article was published in Neale’s Disorders of the Foot, Lorimer, French, O’Donnell, Burrow, Wall, Copyright Elsevier, (2006).

Figure P2c Lateral diagram to illustrate the calcaneal inclination angle and the talar declination angle. A, calcaneal inclination angle; B, talar declination angle. This article was published in Neale’s Disorders of the Foot, Lorimer, French, O’Donnell, Burrow, Wall, Copyright Elsevier, (2006).

Figure P2d Boehler’s angle. This measurement is taken from the lateral X-ray. It represents a line drawn from the superior posterior aspect of the calcaneum and a line drawn from the anterior dorsal aspect. It may be any value from 20 to 40 ° and is of most use in assessing for compression fractures of the calcaneal. This article was published in Neale’s Disorders of the Foot, Lorimer, French, O’Donnell, Burrow, Wall, Copyright Elsevier, (2006).

paresis partial or complete paralysis

Paris point unit of the continental shoe sizing system; there is 6.66 mm between each Paris point (see Table S4)

parkinsonism; Parkinson’s disease; paralysis agitans; shaking palsy see disease, Parkinson’s

paronychia nail fold/sulcus inflammation and infection, often associated with ingrowing toenail

paroxysm spasm of severe pain, of sudden onset

partial dislocation see subluxation

partial nail avulsion see nail avulsion, partial

partial rupture of Achilles tendon see Achilles tendinitis; Achilles tendon rupture

partial-thickness burns destruction of epidermis and superficial dermis, by dry heat

pascal; Pa SI unit of stress; 1 Pa equates to a 1 newton force distributed uniformly over 1 square metre (1 m²); i.e. 1 Pa = 1 N/m²

passive movement body part or segmental movement, not initiated or sustained by the individual, e.g. clinician-initiated/imposed movement

past pointing patient inability easily, readily or accurately to place his/her fingertip on his/her nose, or on the examiner’s moving finger; characteristic of cerebellar dysfunction

pastes see Table V1

patch test; patch testing see test, patch

patella; kneecap large sesamoid embedded within quadriceps tendon at anterior aspect of knee joint; its cartilaginous internal facet articulates with knee joint; exerts pulley-like action within the patellar groove; acts as a fulcrum for quadriceps action, centralizing action of contributory muscles (i.e. rectus femoris, vastus intermedius, vastus lateralis and vastus medialis) (see Table J1); protects quadriceps tendon, allowing knee extensor apparatus to take high load (by lengthening the lever arm, and giving mechanical advantage to quadriceps)

patellar bursae knee joint bursae; allow free movement of deep tissues across one another, and movement of skin across underlying tissues, e.g. when kneeling

patellar groove anterior groove (between medial and lateral femoral condyles) for patellar travel, under quadriceps correct patellar tracking is maintained by patellotibial and patellofemoral ligaments; misalignment of the patella within patella groove causes anterior knee pain (see syndrome, runner’s knee)

patellar tendon reflex see reflex, patellar

patellofemoral joint; PFJ cartilaginous joint between deep aspect of patella and anterior inferior aspect of femur and anterior superior aspect of tibia

patellofemoral joint syndrome see syndrome, runner’s knee

pathogen microorganism (bacteria, fungus or virus) capable of overcoming host resistance, to cause disease

pathogenesis mode of origin or development of any disease or morbid process

pathognomonic characteristic symptoms of a disease

pathological callus hyperkeratosis formed in response to local stresses or biomechanical dysfunction, and of significance to patient/clinician (see Table C15)

pathology tests analysis of tissue specimens, e.g. to identify tissue (histopathology), chemical constituents of body fluids (chemical pathology) or confirm type/sensitivity of any infecting organisms (microbiology), in order to indicate the most effective patient management regime; see sampling

pathophysiological pain; second pain; slow pain pain that encourages healing by inducing protective behaviours; it originates from stimulation of high-threshold polymodal nociceptors (free nerve endings, present in all tissues and responsive to mechanical, chemical and thermal stimuli) and is transmitted along slow-conduction C fibres (which also induce emotional and behavioural responses to pain via thalamic connections, and activate inhibitory pain pathways and the release of endogenous opioids)

pathway collection of nerve axons that conduct impulses from one group of nerve cells (i.e. ganglion) to another ganglion, or effector organ, e.g. muscle cells or gland tissue

patient contract setting patient involvement in the care plan formulation for a specific clinical problem or episode of care, creating patient empowerment and commitment to the chosen (or advised) care pathway

patient education element of patient empowerment; achieved by teaching patients about their illnesses/conditions, encouraging greater involvement in decisions related to ongoing care and treatment

patient empowerment philosophy that patients are active participants in, not passive recipients of, the caring process, and thus should be well informed about all aspects of their health, ‘wellness status’ and disease state, to gain maximum health benefit within the context of their social demands

pauciarticular affecting only one or two joints

paucibacilliary leprosy tuberculoid leprosy; TT leprosy; see Table H7

pectineus medial thigh muscle

pedal pulses see pulse

pedicle stalk

pediculosis louse infestation

PEDIS ulcer classification system see Table U2

pedobaroscope calibrated plantar pressure visualization device, Table G2

Pegasus rocker see Table O4

‘peg in hole’ arthrodesis surgical joint fixation technique; the head of a proximal bone is fashioned into a peg to fit exactly into a hole drilled/gouged into the base of the distal bone

pellagra niacin (nicotinic acid) deficiency (e.g. in chronic alcoholism)

pelvic girdle; pelvis bowl-shaped bony girdle (formed by fusion of paired ischia, ilia and pubi, together with sacrum and coccyx); forming the articulation between trunk and lower limbs, and containing lower abdominal organs; frontal- and transverse-plane curvatures of the female pelvis are shallower than those of the male

pelvic nutation anterior tilt of upper pole of pelvis (in sagittal plane); associated with lumbar lordosis, internal-limb rotation and excess foot pronation

pelvic tilt pelvic girdle asymmetry; the hips (viewed from anterior) are not parallel to the transverse plane/ground surface, and one leg appears longer than the other

pemphigus vulgaris chronic, initially localized but later generalized autoimmune inflammatory disease; characterized by easily ruptured, flaccid cutaneous bullae and blood-filled blisters at the dermoepidermal junction

‘pencil in cup’ deformity erosive inflammation characteristic of metatarsophalangeal joints in rheumatoid or severe psoriatic arthritis (arthritis mutilans); metatarsal head is eroded and the base of the adjacent proximal phalanx becomes increasingly concave see metatarsal head dystrophy

-penia deficiency

penicillamine immune-disease modifying drug, used to treat rheumatoid arthritis characterized by troublesome extra-articular features, or those taking high doses of corticosteroids; beneficial effects of medication take 6–12 weeks to show

penicillin antibiotic derived from Penicillium moulds; bactericidal against non-resistant Gram-positive microorganisms; may provoke sensitivity reactions, e.g. urticaria and/or anaphylaxis; note: patients with penicillin allergy may also react to penicillamine and cephalosporins

penicillinase enzyme inactivating penicillin; produced by some staphylococci

pencilling of metatarsals see metatarsal head dystrophy

percentage mass calculation to convert drug concentration in solution (%) to mass (in mg); based on the principle that 1% solution contains 10 mg of drug per 1 mL of solution (see Table M5)

percutaneous passage of substances through unbroken skin

perforated film absorbent dressings primary wound dressing; see Table D10

perfusion passage of blood and tissue fluid through the capillary bed

peri- around

periarteritis inflammation of the tunica adventitia of an artery

periarthritis inflammation of tissues surrounding a joint

pericarditis inflammation of pericardial membrane, e.g. in autoimmune disease

pericardium fibroserous, double-layered membrane surrounding the heart

periosteum thick, fibrous, vascular membrane investing bone surface, but not articular cartilage; formed of an inner osteogenic layer (containing osteoblasts that form new bone tissue) and an outer, fibrous layer (carrying neurovascular supply to bone)

periostitis inflammation of periosteum

peripheral tissues/structures furthest from the centre

peripheral arterial disease; PAD see disease, peripheral vascular (Table P4)

Table P4 Clinical tests used in the diagnosis of peripheral arterial disease (PAD)

peripheral pain receptors see nociceptors

peripheral pulses see pulse, dorsalis pedis

peripheral vascular disease generic term denoting reduced arterial supply to, and compromised venous/lymphatic return from, the lower limbs and feet; see disease, peripheral vascular

peripheral vascular system system of arteries, arterioles, veins and venules, lymphatics and capillaries subserving peripheral tissues

peristalsis waves of alternate contraction and relaxation in circumferential muscle tissue of a tubular structure, driving contents forward, e.g. movement of blood through the vascular system (see law, Starling’s)

peritendinitis inflammation of Achilles peritendon, due to e.g. acute local trauma, chronic overuse, infection or musculoskeletal disease

peritendon tissue surrounding the Achilles tendon; note: the Achilles tendon does not have a synovial sheath

periungual fibroma see Koenen’s tumour

permeability passage of substances through a membrane

permethrin; Lyclear topical scabies treatment

pernicious anaemia chronic macrocytic anaemic due to gastric malabsorption of vitamin B₁₂, characterized by low red blood cell counts and low haemoglobin levels; it is controlled by (usually monthly) depot injections of cyanocobalamin

perniosis see chilblain

peromelia severe congenital malformations of limbs, hands and/or feet, e.g. congenital absence of hand/hands, foot/feet

peroneal artery largest branch of posterior tibial artery; courses along posterior of fibula deep to flexor hallucis longus muscle; enters the foot anterolateral to lateral malleolus (palpated as peroneal pulse); communicates within foot with lateral tarsal and posterior tibial arteries

peroneal cuboid see syndrome, peroneal cuboid

peroneal (fibular) tendinitis trauma-induced injury to peroneus longus (PL) and brevis (PB) tendons, e.g. overuse injury (tendinitis), chronic tendon subluxation (due to peroneal retinaculum tears from a previous ankle inversion injury), acute tendon subluxation/rupture (in association with recent acute ankle eversion injury); presents as local pain, tenderness and swelling along course of PL and/or PB tendons and lateral retromalleolar area; treatment includes rest (strapping into eversion; immobilization), non-steroidal anti-inflammatory drugs, physical therapies, e.g. ice massage + ultrasound, biomechanical evaluation and orthoses to correct excessive supination at heel strike

peroneal muscular atrophy see disease, CMT disease type I

peroneal pulse see pulse, dorsalis pedis; peroneal artery

peroneal spastic flat foot see tarsal coalitions

peroneal tendon rupture full or partial division of fibres of one or both peroneal tendons (longus or brevis, lying within a common synovial sheath deep to extensor retinaculum) due to trauma, e.g. overuse injury; sudden inversion + ankle plantarflexion

peroneus; peronei peroneal muscles (longus [PL] and brevis [PB]) of lateral compartment of lower limb; action eversion of subtalar joint and plantarflexion of foot at ankle joint; PL and PB tendons lie within a common synovial sheath, within the retrofibular groove at the posterior aspect of the lateral malleolus, and enter the foot deep to the superior peroneal retinaculum (creating a point of ischaemic stress, leading to chronic degeneration and degenerative changes in PL and PB tendons; see subluxing peroneal tendons); PL and PB common tendon sheath divides to form individual sheaths at lateral side of foot

peroneus brevis; PB extrinsic foot muscle within the lateral compartment of lower leg

peroneus longus; PL extrinsic foot muscle, within lateral compartment of lower leg

peroneus tertius small extrinsic foot (forms lateral part of extensor digitorum brevis), within anterior compartment of lower leg

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