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I have a current patient who i have been seeing for about 7 years now on and off. They are suffering from a HD underlying their 1st MPJ which sits within some very old scar tissue form a Verruca. 20+ years ago the pt had what was a wart and the GP cut it out and stitched it back up which obviously left a scar and now also a corn forms within it making it difficult to walk without compensating with other parts of her body. She has had pressure deflective orthotics with another podiatrist which they felt were useless so they are happy with general treatment every 4-5 weeks . We debride the area down and depending on her activity place Agno3 or sal acid on it to gain better relief for a longer period of time. They are happy with this. What else can I do for this patient. All advise would be greatly appreciated. Thanks

 

The 'super cushion' insole from Foot Bionics (made in New Zealand) offer the best cushioning I've seen, and if you adjust them with an apertured FF valgus type of thing, these hyperkeratotic pressure lesions usually decrease markedly over a few months.
As far as I know, fat transfer isn't working for feet yet, so minimising ground force is really all we have besides debridement?

 

The old scar tissue can be excised again in toto and the wound closed by deep and superficial suture. Provided the patient is not prone to keloid etc, offloading the wound during the first 2 weeks should reduce the scar to a tiny fine line. Failure to adequately offload the wound during healing is the primary cause for excessive scar formation following plantar incisions.

LL