Toe prop for Clawed Toes

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I saw a patient today who came to me from another podiatrist.

The patient presented with clawing of the lesser digits 2-5 in both feet with HDs on the dorsum of 2nd and 3rd PIPJ in both feet.

I felt the patient could have benefitted from toe props; pt does not have any sensory loss and has sufficient mobility to reach his feet. His shoes are also adequate in size to accomodate the toe prop. As the HDs are on the dorsal aspect due to irritation from footwear, would it be ok to put the toe prop on top of the toes, with the theory that it will straighten out the toes or is this likely to create more pressure? The previous podiatrist had also given him a toe prop, however, they had put it under the toes (or perhaps the pt put it there)...

Just wondering, where would you likely put the toe prop? Alternative suggestions also welcome.

Cheers

 

Silly me, I meant I was thinking about him today, but he came in on Friday. Today is Sunday (in Oz) and it'd be nice to have a break from work !

 

Deeper toe box shoes, if the Heloma are on the dorsal aspect!

 

It varies - you can put it under the toe to dorsiflex the DIPJ to 'correct' the clawing, or you can put it dorsally over the proximal phalanges to off load the lesion ... 6 of one, half dozen of the other

 

Been doing just that for the past 30 years since the Heart of Midlothian first demonstrated the wonders of silicone putty in Auld Reekie's premier foot joint. Certainly seen some correction of retracted/clawed toes and props work tremedously for apical lesions, but I would be interested to know of any published papers supporting the corrective element of the therapy....

 

If they had appropriate footwear (which it doesn't sound like in this case) you could do both. (dorsal PIPJ prop and plantar DIPJ prop) all in one device.

With the plantar prop I find a more rectangular cross section of the prop is better than the conventional circular cross section. Both comfort wise and it's ability to 'straighten out" the digit/s.

Con

 

netizens

Orthodigital therapy has been around since the 30s and was all the rage when foot surgery was frowned upon.

There are two approaches to the problem you may either:

pad the lesion (on the dorsum) i.e. hope to increase the surrounding surface area and reduce peak pressures and shear over the lesion. This may be the preferred method if the lesion is acute.

Long term
Applying a siliocne prop under the three middle toes with spacers in between toe 1/2 and 4/5. Adopt a subtalar neutral maniputlation as the putty is setting then with the thumb smooth off to meet the contours of the foot. The platform under the middle three toes increases surface contact area on the plantar surface of the foot (reducing peak forces). Walking over the toe post exercises both intrinsic and extrinsic muscle leaving toned muscles capable of dynamically resetting the digits (straightenting effect is determined by the QOM and ROM of MPJs and IPJs).

Subsequent visitsrepeat the the casting with silicone putty and compare to previous toe post. length between toe 2 and toe five should become significantly shorter (due to increased plantar interossei tone); and individual molds for each toe may present greater adduction /abduction as the individual toe positon. Lay a pencil in the furrow and compare toe positions form device 1 and 2. Changes to the depth of hillsand valleys on the toe post captures the sagittal clawing component of the toes any reduction infers improved lumbrical control.

toeslayer

 

I know all that too (I think..) I just can't say it as well!

 

Hello all,

Now what cunning ways have you devised to support the clawed toes of someone who can't get to her feet? I can't see how to fix a prop (or dorsal pad) in place without it causing a problem getting the shoe on. I'm sure someone's solved it...

Thanks,
Lucy Davey

 

I will often use 10mm semi compressed felt to the plantar digit with hypafix to secure. Combine with dorsal padding if required.
This stays in place for several weeks, through baths and showers, often until next visit.

No problem with shoes and comfortable patient :drinks

 

Thanks for reply. What I really meant was that I don't know how to make something I can put inside her shoe. I want to attach something to a basic insole that will prevent a severe recurring apical corn on a rigid clawed toe. She's got loads of room in her shoes. If I made a silicon support and glued it to regen I think it would get pushed off by the action of inserting the foot. More elegant ideas anyone?
Lucy

 

Yep- but does depend what facilities you have.

Silicone won't glue very well either. But if you have a bench grinder it's fairly easy to make a low density EVA toe prop and that will adhere well to an insole especially with a top cover.

I've also done quite a few CADCAM orthoses with a toe prop built in- comes out a treat milled in PU. Just triple check the measurements of where you want it!

Cheers
Ian

 

Have you tried mobilising the digit? Getting some movement back can really help.