Mallet toe orthotics
Brian Moore
Description
Collection
Title:
Mallet toe orthotics
Creator:
Brian Moore
Text:
I have a patient with a very strange foot condition.Upon visual
inspection,the feet look normal aside from callous formation on the 1st,5th and entire heel
area.These keratosis formations are thick and can be shaved with a razor on a
daily basis.The patient is in mid-thirties and leads an active lifestyle.The
problem is that when the foot is simply bearing its own weight at sitting,the
2nd-5th toes are mallet/hammered slight but,flexible enough to straighten.When
patient stands and starts ambulating,the 2nd-5th toes elevate upwards onto
the dorsal surface of the foot and point straight to the sky. The big toe acts
as a keel and controls the direction of the foot as if the all of the toes are
touching the ground.The toes can be forced to stay straight but it is painful
and I fear skin breakdown might occur.the patient has no real foot wear
options and goes barefoot most of the time.I have seen many deformities but this is
the strangest toe problem I have ever seen.The physican has ordered semi rigid
arch support to aid in the reduction of the keratosis problems but how can
you provide orthotics the unload callouses without taking the toe problem into
account?The arch structure is flexible but high.No tone is present and
neurological problem have been ruled out.My suggestion was to seek the advice of and
orthopedic specialist(MD) to maybe look at tendon release as a possible
solution.Custom shoes would look beyond terrible and the patient would refuse them
at first glance.This patient is and avid dancer and even a runner,thus the
callous problems.I am not comfortable with dorsal surface bearing orthosis to
imoblize or restrict the toes but I am open to suggestions.I wish I had a picture
to send.This is not a what if scenario,this is a real patient.Standard weight
bearing unloading is not effective(met,heel,st,etc..).The standard methods
seem to have the opposite effect,the more you try to unload and redirect pressure
the worse the toes get.The pain the the callouses get better and the patient
loves that but I can't glue cat's paw to the insole and call it a shoe.Any
thoughts.Thanks in advance.
Brian Moore CO
inspection,the feet look normal aside from callous formation on the 1st,5th and entire heel
area.These keratosis formations are thick and can be shaved with a razor on a
daily basis.The patient is in mid-thirties and leads an active lifestyle.The
problem is that when the foot is simply bearing its own weight at sitting,the
2nd-5th toes are mallet/hammered slight but,flexible enough to straighten.When
patient stands and starts ambulating,the 2nd-5th toes elevate upwards onto
the dorsal surface of the foot and point straight to the sky. The big toe acts
as a keel and controls the direction of the foot as if the all of the toes are
touching the ground.The toes can be forced to stay straight but it is painful
and I fear skin breakdown might occur.the patient has no real foot wear
options and goes barefoot most of the time.I have seen many deformities but this is
the strangest toe problem I have ever seen.The physican has ordered semi rigid
arch support to aid in the reduction of the keratosis problems but how can
you provide orthotics the unload callouses without taking the toe problem into
account?The arch structure is flexible but high.No tone is present and
neurological problem have been ruled out.My suggestion was to seek the advice of and
orthopedic specialist(MD) to maybe look at tendon release as a possible
solution.Custom shoes would look beyond terrible and the patient would refuse them
at first glance.This patient is and avid dancer and even a runner,thus the
callous problems.I am not comfortable with dorsal surface bearing orthosis to
imoblize or restrict the toes but I am open to suggestions.I wish I had a picture
to send.This is not a what if scenario,this is a real patient.Standard weight
bearing unloading is not effective(met,heel,st,etc..).The standard methods
seem to have the opposite effect,the more you try to unload and redirect pressure
the worse the toes get.The pain the the callouses get better and the patient
loves that but I can't glue cat's paw to the insole and call it a shoe.Any
thoughts.Thanks in advance.
Brian Moore CO
Citation
Brian Moore, “Mallet toe orthotics,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/223064.
