Fixing a short toe.

 
Here is an example of a patient that had a really short fourth toe. The technical term is called brachymetatarsia and this is a condition where the toe is actually shortened in the middle of the foot called the metatarsal bone.  Since that area is too short, the toe looks like a midget and so in order to treat this there are a lot of different options. The option that we chose here is something called lengthening of the metatarsal and we use something called an external fixator, which is this little black device that goes on the top with a few little pins that go inside.  So what happens for this patient, you actually make a little incision on top and you cut through the bone in a proper position and you put two pins before the cut and two pins after the cut and you put that little black device on there.  Then every day you want to increase the length about a millimeter until it’s out to the proper length, and you also see in this picture, coming out of the toe there’s a little pin and that’s just to hold the toe in the proper position so that it doesn’t cock up during this process of lengthening this short toe or brachymetatarsia. 
 
To Your Health,
Dr. Donald Pelto


Interview - Patient with ulcer on the outside of the right foot


This episode contains an interview that successfully healed a wound to the right foot.  This goes over how treatment was done for the patient.  


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Wound healed after 7 months


In this episode: Here is an interview with a patient that had a long standing wound on his foot that needed a wound VAC and 7 months of staying off his foot.  


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How to move when you can't walk?

Many patients that come to the office have a period of time where they’re not supposed to walk on their foot.  This may be due to a sore on the bottom of your foot, heel pain, having surgery, or having another foot condition that you’re not able to put pressure on either the right or the left foot. The first thing to consider is that if it’s your right foot, you’re not going to be able to drive either, so you have to make arrangements for rides to your doctors’ visits; for example, if you have a bunion surgery on your right foot and you can’t put pressure on the foot.  But the main reason that people can’t walk or put pressure on their foot isn’t usually surgery.  It may be surgery, but most of the time it’s due to a foot sore or a foot ulcer.  These ulcers are caused by pressure, and if you have one of them and you have a condition called neuropathy that you can’t feel the bottom of your foot, and then you have to find another way of keeping the pressure off of the bottom of the foot.  So the question is how do you move when you can’t walk?  I’ll give you a few options. One of the options that works well for a lot of patients is called a knee walker.  What this is, is kind of a like a scooter that has a place where you can put your knee on there, either the right and left knee, and it has a steering wheel that can guide you around wherever you need to go. This is a very good device, especially if you need to be for an extended period, for example six weeks or longer, without putting pressure on your foot.  You can wheel around, you can continue to do work and do your activity.  Another option to get around is called the Freedom Leg. This is a device that actually straps onto your leg and puts all the pressure through your thigh and doesn’t put pressure on the foot.  So this can allow you to walk somewhat normally by putting the pressure forces through the area of the leg and the thigh.  So these are a couple of options that you can use to help not put pressure on your foot when you’re allowing something to be healed.

To Your Health,
Dr. Donald Pelto

More than a blister, almost a wound.


In this blog post, I want to talk a little bit about blisters, calluses and wounds.  For those people that have diabetes, you really have to be careful about wounds, but most people, they say, “Well, I’ve never had a wound,” or “I don’t have a wound,” but before a wound happens there is usually a callus or a blister. We can see this patient here.  He has a blister on his big toe joint and he actually got a new pair of shoes that caused that blister.  If that blister isn’t treated and this patient has poor blood flow, there may not be enough good blood to heel that, and as well if this patient doesn’t have the best feeling or neuropathy, that can cause that callus or that blister to develop into a sore, so you really have to be careful to make sure that your shoes are deep enough for your feet and this way you need the extra depth shoes if you have diabetes or if you have curved toes, and you should be professionally fit for those shoes. That’s why insurance does cover one pair a year for most people with diabetes.  Be very, very careful of blisters and if you have a blister and diabetes, you should really see a professional about it, especially if it’s not healing right away.

To Your Health,
Dr. Donald Pelto 

When your bone needs a lift.


Here is an example of a patient that has a very prominent callus on the bottom of the third metatarsal head.  You can see it in this picture.  This patient actually has a foot type that we call a cavus foot type where the front of the foot is very far down and the heel is far down and the arch is very high. This type of a callus can be very painful and if you look at it on x-ray, you would see that the bone is slightly larger or slightly pointed down.  That could be from some type of an injury or they could have been born with it.  When something happens like this, you can do a little lift there, meaning you actually take the saw and you can cut through the bone in a little V fashion and allow that bone just to kind of lift up ever so slightly to take care of that callus.  Otherwise, that callus is going to come back over and over again.  As well, if you don’t want to do that, or even prior to doing that, you can try an orthotic or an insert that goes in your shoe to take the pressure off of the area.  As well, you can take a pad to put it on that area.  A U-pad works very, very well.  It’s from Dr. Jill’s; that’s a company that makes gel pads.  That may help temporarily as well as trimming it off; by trimming the callus every two or three months the patient is going to be a lot more comfortable. 

To Your Health,
Dr. Donald Pelto

Don't mow the lawn if you have diabetes.


In this episode we're going to talk about a patient of mine that developed a wound after mowing the lawn. As well go over some precautions of what types of shoes and socks to wear and a few things to look out if you are mowing the lawn and you have diabetes and neuropathy.


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