Painful curved toe should you pad or amputate?

   
Here is a patient of mine that had a painful 3rd toe.  This patient in the past had to have another surgery that used one of the tendons on the top of his foot.  As a result the toe has curved under the 2nd toe.  I trimmed off the callus and there was no ulcer or wound under the area but it was still painful.  There are a couple of options for treating this condition.  

1.  We could try padding and wider shoes to prevent it from coming back and if it does we could trim it down.  That may require treatment a few times a year.
2.  We could remove the tip of the toe so the patient wouldn't be walking on it any more.  That is more of a surgery.

This patient chose treatment with the pad seen on the toe. He felt much better and was able to return to work.