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I have recently come across a patient with a build up of callus under the 1st IPJ on both feet. there is no other callus evident on his feet. Has anyone any idea why? I thought it was likely to be on the medial border once the 1st MTPJ is deteriorating. i am new to podiatry and would value any suggested reasons.

Carol

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Most likely cause of hallux IPJ callous is due to hallux limitus/rigidus at MPJ.
This is causing a sagital plane block and the compensatory motion at propulsion is forced on the next distal joint being the IPJ where hyperextension is progressively developed.

I would suggest testing the ROM at the MPJ then address this issue with footwear/orthotic modification and callous should reduce.

Think first MPJ dysfunction:

• Hallux rigidus
• Functional hallux limitus
• Structural hallux limitus
• Delayed windlass
• High force to establish windlass
• Increased dorsiflexion stiffness of first mpJ

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Craig Payne
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Thanks for the prompting I have looked at some of these, but will check all out.

Think second that there is a secondary ossification centre causing an 'os sesamoidum interphalangeum' .

These can be quite cartilagenous and may only be easily seen on a soft tissue contrast XR or MR. They can often be palpated though.

LL

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Remember, it's just a foot.

I have seen many patients with this problem. Usually it is a hallux rigidus causing the increase in pressure at the ipj. Because there is minimal to no motion in the hallux for normal toe off, the patient has to compensate. You might see a twist in the hips at toe off, premature hip flexion, or a pivot on that foot. The sheer force causes a callus formation. I receive alot of referrals from local podiatrists and wound care centers that are diabetics with infected ulcerations at the 1st ipj that started out with thick callusing, and have a hallux rigidus.

We usually treat with custom fo's, rocker bottom shoes, accomodation sub ipj to decrease pressure.


Joe Eads, C-Ped

Carol:

I have one more to add to the excellent list by the others. Sometimes if the patient has a large degree of excessive dorsiflexion available at the hallux interphalangeal joint (IPJ), [which may, in turn, be caused over time due to compensation for hallux limitus] they will be more likely to develop calluses plantar to the hallux IPJ.

By the way, welcome to Podiatry Arena and thanks for asking such a good question.

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Sincerely,

Kevin

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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
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Voice: (916) 925-8111 Fax: (916) 925-8136
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