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May 24

Written by: Larry Huppin, DPM
5/24/2010 5:16 PM

I had a client call with the following question today: 

QUESTION:
Do you have any idea of how to successfully treat a sheer varus friction type of callus at the plantar tip of the 4th toe? In theory, a good pair of functional orthoses with a Spenco extension should work. But I have never had good success with this. Any suggestions?

ANSWER
This is a tough keratosis to treat with orthoses, but here are a couple ideas. The following information assumes you already have an orthosis that is providing adequate control of the foot.

The most important thing is to use a topcover on your orthosis that will show an impression of areas of increased pressure. For example, Diabetic Topcover works well. This is a tri-layer material with a Poron bottom layer, soft Plastizote middle layer, and a leather topcover. EVA is another material that will show an impression.

After the patient has worn the orthsis for a few weeks, these covers will show an impression/indentation in areas of increased pressure. This impression will act as a guide for you to add accommodations for the callus. Here are two ideas.

1. Using a piece of Poron, create a crest pad by gluing the Poron onto the bottom of the cover, so that it will lie in the sulcus of the toes when the patient stands on the device. Like a crest pad, this may help straighten the toes as the patient stands on the device..

2. Using Poron or Korex add a horseshoe or doughnut accommodation around the distal tip of the toe. The impression on the topcover will guide you as to exactly where the accommodation should go.

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