Distal toe ulcer
doer human
Description
Collection
Title:
Distal toe ulcer
Creator:
doer human
Date:
12/10/2009
Text:
Hello everyone,
I am an attending orthotist at a major local hospital wound care clinic. I
think I do pretty good, but I'd appreciate collective input on one
particular problem that I can not find solution for most of the times.
I am referring to the very distal toe ulcerations. It is always medial
distal on a big toe and is quite resistant to any treatment they do at the
clinic. Right in the area where most of us slight weight bearing callus on
the big toe. Not all of those are diabetic, some just neuropathic. Several
are too tall patients, using clinic lingo.
Orthotically, I have tried custom inserts, custom relieves, foot plates with
toe cutout to stiffen the insert+relief, shoe lasts to stiffen the
shoe+custom insert+relief, custom rockers/rollers. I think I mentioned about
all of what I tried.
So far, I managed to close 2 patients with some odd medial vertical buildups
added to the insert, to provide total contact against the ulcer. In most of
the cases, I can stop ulcer from progression, but I'd feel better being able
to close them. Of course, clinic keeps packing thick pads into the area.
In general, I am very particular about having all through total contact arch
support and always post my inserts. For these particular cases, I shift
weight more lateral with properly shaped plantar insert surface/shoe sole
modifications.
What else is that I am missing?
Your input is kindly appreciated. Have another one coming tomorrow.
I. Lesko, CPO/LPO
I am an attending orthotist at a major local hospital wound care clinic. I
think I do pretty good, but I'd appreciate collective input on one
particular problem that I can not find solution for most of the times.
I am referring to the very distal toe ulcerations. It is always medial
distal on a big toe and is quite resistant to any treatment they do at the
clinic. Right in the area where most of us slight weight bearing callus on
the big toe. Not all of those are diabetic, some just neuropathic. Several
are too tall patients, using clinic lingo.
Orthotically, I have tried custom inserts, custom relieves, foot plates with
toe cutout to stiffen the insert+relief, shoe lasts to stiffen the
shoe+custom insert+relief, custom rockers/rollers. I think I mentioned about
all of what I tried.
So far, I managed to close 2 patients with some odd medial vertical buildups
added to the insert, to provide total contact against the ulcer. In most of
the cases, I can stop ulcer from progression, but I'd feel better being able
to close them. Of course, clinic keeps packing thick pads into the area.
In general, I am very particular about having all through total contact arch
support and always post my inserts. For these particular cases, I shift
weight more lateral with properly shaped plantar insert surface/shoe sole
modifications.
What else is that I am missing?
Your input is kindly appreciated. Have another one coming tomorrow.
I. Lesko, CPO/LPO
Citation
doer human, “Distal toe ulcer,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 25, 2024, https://library.drfop.org/items/show/230987.
