Hi everyone
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This is my first post to Pod Arena so I hope this works!
I was hoping to get your opinion:
A 65 year old lady presented to me 3 months ago with a very painful 5th toe. It has been bothering her for several months. On examination I noticed a large heloma durum on the medial aspect of her 5th DIPJ. Slight surrounding redness was present and it was extremely tender to touch. No infection was present. She walks very heavily on the lateral aspect of her feet, wearing very tight/small enclosed runners that have increased pressure to the 5th.
I enucleated the heloma (which was very painful!) and a small amount of bleeding prevented me from seeing the base clearly. I did not feel it was fully enucleated however left it and asked for a review in one week. It was to be offloaded and redressed by my pt. I advised on the most suitable footwear to reduce pressure. I ordered an xray to look for abnormalities of the underlying condyle.
I didn't see her again for 5 weeks, and on return I carried out the same treatment. She had continued to wear the same footwear. The pain had increased and I advised her to return in one week for debridement under local anaesthetic and tornicot. This did not help relieve the pain either. I advised oral antibiotics, daily/twice daily dressing with medihoney and offloading.
My pt has an ulcer of approximately 4mm x 4mm x 4mm.
I would like any input on if these interdigital corns can commonly lead to ulcers and whether or not I should have done anything more? I havent come across such a deep interdigital heloma durum like this before - and they usually heal straight away! Patient compliance plays a huge part and is frustrating!
Regards
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