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Hi,

I have a patient with a mallet toe that has had previous (failed) surgery to straighten the toe. She has presented with a deep apical corn and a subungual corn.

I was hoping for some advice regarding management of stopping them returning.

Has anyone had any luck with a specific device? ie, covers?

I have checked footwear and they are deep enough to not be causing any pressure, but the shape of the deformed toe leads to pressure on the apex during gait.

Many Thanks for any help/advice.

 

Hi Lucy :welcome: to Podiatry Arena.

Photo - a picture tells a 1000 words and all that may help get better more detailed advice.

 

Hi Lucy

I would advise her to see the practitioner who originally carried out the surgery (nobody is perfect). If she is unwilling to do that, then advise her to seek an opinion form a Podiatric Surgeon, because to the best of my knowledge there is no device which can fully straighten the toe.

All the best

Bill

 

Having enucleated, is the digit flexible enough to be 'propped' to raise the apex from weightbearing or have gel digital sleeves been tried? or padding inside the shoe to cushion. back to basics would be my suggestion, treat the symptoms - then perhaps retrace the history of the surgery.
good luck :)

 

Rose bland silicone prop after enucleation, perhaps stabilised over 2-3 toes. You mention deep shoes, do yo mean long? shoe design commonly worn?, general posture ie anteriorly displaced COM? gait action? compliance with appropriate footwear?

 

Reminds me of a patient from a few years back. Similar presentation and refused all sorts conservative props, covers, sleeves shoe mods etc.

Instead of the conventional she had the distal phalanx surgically amputated.Did wonders for the toe in questions bet returned very frustrated when similar lesion appeared on the apex of her 3rd!!!

 

Dear Colleague:
The solution to this problem is the base wedge osteotomy in the dorsal middle phalanx and flexor tenotomy or the removal of the tip of the distal phalanx, if the affected toe to straighten it would break the digital formula favoring recurrence.
Another alternative would be a shortening replacement with fixation to secure the position of the fingertip.
Best Regards:
Jose Antonio Teatino
Professor of Surgery
The Academy of Ambulatory Foot & Ankle Surgery