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Hi,

I'm new to this site and this is my first post, so apologies if this is in the wrong place.

A colleague of mine has ventured to pastures new and I have subsequently taken his case load on. I recently saw a pt. who displayed heavy callus under both 2nd - 5th MPJs, which can become painful after some time.

She was given a cobra pad poron device which, unsurprisingly, isn't reducing the callus...this basically got me thinking about the multifaceted nature of this callus build up.

As stiffness appears to be the new black! You could say she had reduced dorsiflexion stiffness and this is evident, little pressure to dorsiflex the first ray. Not overly, but the first ray was slightly dorsiflexed. There was also digital retraction and distally displaced fibro fatty padding, exposing the met heads. This lead me to thinking about prescription. I was considering the effect of a shaft pad - the ray is slightly dorsiflexed and this will "bring the ground up". Perhaps a reverse mortons would help, or 2 - 5 post - but this may increase GRF at the point of the callus build up. Or perhaps a lateral forefoot wedge to shift the force onto the hallux away from the mets.

In short, I wasn't sure whether to use a first ray stiffer extension and place a soft malleable material under the rest of the forefoot, or a first ray cut out/addition ie morton's or reverse morton's extension, or a laterally placed wedge alone or in combination. I also gave her footwear advice (as always! :bang:) and stretches

I would be grateful for any thoughts. Incidentally, I have regularly read this forum both professionally and as a student and found it informative and useful, as well as enjoying the banter!

 

:welcome: to the Arena as a Poster

Callous is form through a combination of pressure , shear and friction forces.

So what you want to do is reduce these forces at the point of callus.

So a pad that " brings the ground up " or provides a ORF at the 1st, 3rd and 4th mets and also reduces friction and shear forces at the 2nd and 5th.

Triceps Surea stretching so Forefoot pressure and time of load is reduced.

Mobs to reduce ankle joint dorsiflexion stiffness.

and of course palliative treatment to reduce the callous

Hope this helps