6/15/2011 10:20 PM
A patient with persistent forefoot callusing presented today for debridement.
He primarily has sub 3rd met head and hallux base callusing, with fat pad atrophy. He has a custom molded functional foot orthotic that I have tried to modify with various forefoot extensions to pad and offload the main callus locations.
The initial orthotic modifcation was actually placed in the wrong location, and did not offload the 3rd met head on either foot! I began by applying a dual density, full length topcover of plastizote and poron to pad the entire foot. I then applied felt to the orthotic to offload the above locations bilaterally. This addition worked for the patient for about a month, until he became more active. Today, I applied a metatarsal bar to the bottom of the orthotic, just proximal to the lesser met heads. This modification can be done quickly in the office because it is adhesive. If the patient feels worse after a fair attempt at breaking in the addition, he can easily peel it off and report back to me.