Hi Pods,
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Can you help me out with this one please?
Middle aged lady with a 2 month history of blisters occurring on apex OR distally on plantar surface of 1st or 2nd toes bilaterally. (pt sent me some photos attached; unfortunately photos are not very clear but will give you some idea)
-No Significant medical history
-No medication
-Nil allergies known
-Very early stage of HAV bilaterally
-Active lady that walks 1hr /day (outdoors and/or treadmill)
-Does not perspire much
-Pt is well otherwise
She indicated to me that she tried various blister tapes and has bought new shoes however new blisters appear once old ones are healed.
On viewing her gait (3 weeks ago)I did notice that all digits plantarflexed strongly for ground purchase. Also due to slight hallux deviation, medial aspect of 1st IP joint was subject to alot of pressure during propulsion.
Apart from all the general blister prevention info such as prevent moisture build up, taping and footwear recommendations it was obvious to me that I should attend to the high amount of distal pressure that the 1st and 2nd toes were subjected to. Therefore I made ONE soft foam type pad and ONE otoform pad to distribute pressure proximally to that of the blister sites.
The result was that the original blisters healed well but new blisters formed under both types of padding I made.
Now my question is?
1) Has anyone dealt specifically with similar cases before?
(I tried to think laterally and more systemically as this sudden onset seems peculiar to me.)
Thanks All,
Con
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