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hI all,

Just seen a little boy aged 2/3 both 2nd DIPJ's appear abducted and are starting to over lap 3rd toes.

Don't really see a lot of children and am a bit scared, my advice was a direct referral to orthopeadics.

Is there anything else I should be thinking about in the meantime, I was thinking home physio but I am not sure it would be of benefit.

cheers in advance

scott

 

Its really benign and a simple splint with tape is all that is needed. Why refer?

 

Hi Craig,

How often should the splint be applied and how long should each application last for?

cheers
scott (I think i have over reacted, just like a Paranoid parent!!!)

 

Just use 1cm wide tape to hold it in position between adjacent toes - get the parents to apply it daily ...often as short as 6 weeks to correct.

 

will give it a go, cheers

 

Another idea: I have found that an interdigital Ottoform device works quite well if the deformity is easily reducible. I make it like a splint for the affected toe (plantar, medial and lateral aspects surrounded) with more bulk on the lateral side of the DIPJ to adduct. Review in about 6-8 wks and make a new device to fit as the deformity reduces. Easier for the parents than taping, too.
Beth.

 

cheers Beth,

good idea, will give that a try this week!!

cheers scott

 

One resulting factor of an abducted 2nd DIPJ, can be a gryphotic nail on the 3rd digit.
I have seen this in a 20 month old child.

 

Hi not quite on the same thread but last week saw a 2 year old with 2nd toes mildly overlapping B1st toes, child was seated, went through all the taping/splinting etc.
Then as child became more comfortable got him to leave mums safe knee. Standing he was pronated to weight bearing on his navicular, with very little effort could put him into neutral position, instantly the overlapping was gone!:confused:
Now looking at footwear and controlling pronation and will see where the toes go?

Cheers

 

Just a thought, have agood look at the current shoes, l mean all not just the ones they are wearing on the day before you start putting any "interdigital" devices on.

l am not knocking this practice, you just need to be sure that there is still enough width in the toe box for the extra additions.

Another wild thought this one, are the current shoes long enough for his second toe?

 

Thanks David always standard to check the shoes

 

If the shoes are long enough there shouldn't be any problem with an otto-form devce. If made properly it will just go around the toes and interdigiatly, very thinly as it only needs to last for 4-6 weeks. There shouldn't be any problems with height or width in the toe box of the shoe if you ensure there isn't too much bulk and that the object is to allign. You just need to make sure you make it quickly and keep the child very still and distracted. Hold the toes where you want them and get the silicon in fast.

I'll often get mum to use my bubble blowing machine while I the silicon in and around the toes. Make a big song and dance while it sets and there you go. Instant comfortable splint. Far easier than taping every day.

 

Hi
I know this is an old thred but I could do with some advice.
I've been seeing a five year old boy with bi-lateral retracted 2nd toes. For the last year Ive had the mother taping the toes in a planterflexed possition. A similar form of taping to the one I use for planter plate tears.
That was unsuccesful so tried otoform toe wedges, about 1cm thick on top. Kid is fantastic doesnt move a muslce while im molding. Its been three months since I dispenced these and still no change.
Have any of you tired any ridgid toe splints someting similar to the darco HAV spilint?
I know in the long term this probably will not be detremental the childs development. Parental concern is high, and theres the obvious cosmetic issues.
Any help would be fantastic.
thanks in advance
Gez