Apical HD/Ulceration

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Hi,

Quick question for a bit of advice/opinion?

I have a pt with history of R3rd apical ulceration and currently suffering with HD, have tried the usual pressure relief devices ie silicone props and after initial success this started to fail as the device wore; so have moved onto ottoform and having difficulty repeating the success....any tips on making ottoform pressure relief device for this problem?

Many thanks

 

Silicon prop would cushion the toe from ground reaction forces.Ottoform which sits plantar to the proximal phalaynx would not offload the toe tip because of the flexion contracture of the long flexor tendon which uses the ottoform as a lever.

you can add a 6mm poron forefoot extension which ends just proximal to the distal phalaynx and 4mm EVA proxiamal the metatarsal heads.

Flexor tenotomy is very effective in these type of ulcers.

ive attached a Doc ive done reg this procedure and its effectiveness in treating apical ulcers.

hope this helps.