Post 'hallux limitus' exostectomy

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Have just had a 91 year old male patient p/w ' a pain in my right foot'
only hx of 'low back pain' and only on anti-hypertensives
2005'ish had r/1st metatarsal (distal) exostectomy by podiatric surgeon; also 'did something to my (r/plantar fascia)"
presenting complaint; c/o r/1st medial interphalangeal joint pain when weight-bearing; no lesion no erythema
gait; does not plantarflex r/1st > no ground contact >> passive rom r/1st mpj seems adequate and certainly has strength in the r/1st plantarflexorsl
r/2nd apex erythematous and swollen, mallet like appearance
supination resistance test; very hard b/feet

have fitted a r/cluffy wedge and replaced section of sock lining beneath r/2/apex with a poron/plastazote plug; also fitted bilateral rearfoot varus wedges; >> pt ecstatic walking out of clinic but have had many with symptoms returning 'after a few weeks/months" so would appreciate any suggestions, mark of canberra

 

Greetings Mark.
I'm having trouble visualizing your modification could you perhaps elaborate. specifically changes to the second.
Brendan.

 

Greetings Mark.
I'm having trouble visualizing your modification could you perhaps elaborate. specifically changes to the second.
Brendan.

 

Goodaye Brendan, thanks for replying.
I prefer modifying sock linings/insoles rather than making removable toe buttresses mostly. As the 2nd apex was being stressed, taking, I assume, most of the ground reaction force that the hallux would otherwise have, I removed the section of the sock lining directly beneath the r/2/apical lesion (easily identified by the depression in the sock lining and replaced it with a plastazote/poron plug (near circular in shape). I don't like adding toe buttresses to the top of sock linings/insoles either as I think it often forces the digit into a 'claw' position as the apex 'catches' on the buttress when putting the foot into the shoe.
all the best, mark