I am treating a patient at the moment who has a hyperextended IPJ of the hallux. Therefore the distal condyles of the proximal phalanx is receiving excess ground reaction forces, resulting in callus build up on the plantar surface of the IPJ, and at last appointment a breakdown underlying the callus was present. I have attempted to off load the area by placing some felt in her shoe just proximal to the high pressure area. This is in an attempt to DF the MPJ by applying pressure to the proximal phalanx, therefore off loading the plantar IPJ. It's good in theory but I'm not confident this will work and am concerned that she may present with an ulcer next visit. Has anyone got some suggestions on how I should go about off laoding the area??
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