Diabetic with a new pair (about 1-2 months old) of accommodative orthotics. He came in with a large sub 1st met head and hallux base callus wanting options. No accommodations are on the devices, these are simple inserts. On exam this is a neuropathic diabetic, h/o ulcers to the feet, presently intact skin and a noted hallux rigidus. The patient is worried about re-ulcerating.

Couple options: one way to reduce friction is placing a PTFE patch on the top of the device where the calluses are located. This should reduce shear frictional forces and therefore decrease callus formation. Another option, since the patient has a rigidus component, is to build on a reverse morton extension on the bottom of the orthotic to offload and the problematic callus. Because of the rigidus component, I opted on the reverse morton extension and combined this with the patients front rocker diabetic athletic shoes to additionally reduce stress through the forefoot. We will follow up with him in a next few weeks!