Digital Corns and Callouses
Continuing our recent theme of debunking some long held theories about common foot problems, the subject in question today is digital corns. Again our online sources identify YOU as the source of the problem, or more specifically your inability to choose a shoe that doesn't crush your toes (insert eye roll emoji).
Ok, I think we have all tried on a shoe that was a little tight for a special occasion but for general everyday life, most individuals have sufficient intelligence to know better.
Daily, we encounter patients who are suffering from painful corns on the tips of their toe, in between, or on the top of one of their toe joints. They report gradual formation of the corns over time and often they are wearing good quality correctly fitted shoes, so what happened?
In the vast majority of cases a mechanical functional instability results in overuse of the long digital flexor and extensors muscles.
This influence during the gait cycle causes the toes to contract (curl/claw) so that the tips of the toes are driven in to the ground, or the joints of one toe rub against the bony expansion of the joint on the neighbouring toe. Sometimes the toes contract so much, or the toes are pulled up (retracted) into the top of the shoe causing pressure and the associated callous and corn is born.
Whilst observing out patients standing/weight bearing often there is little or no evidence to support this claim, unless the offending toe is become fused or hammered. However, viewing the individual walking barefoot with our Pedigait system (our digital video gait analysis system) we can see stride after stride in slow motion showing exactly how the lesion was formed and which were the contributing structures. Additionally, If these forces are allowed to persist long enough and in combination with other systemic illnesses like diabetes, they can result in tissue breakdown, ulceration, infection, loss of locomotion and a huge undesirable change in the quality of life.
Treatment must be based on a clear understanding of the underlying cause; otherwise, without addressing this, most interventions will be futile and unsuccessful in the long run.
So I’ve wanted to do a post on this phenomenon for ages!
I am amazed how frequently i find myself especially with new patients feeling like the Inquisitor, dragging out information regarding medical history.
Whether this is fuelled by a distrust in modern medicine or a previous bad
experiences in a doctors office, it greatly reduces the likelihood of success or
satisfaction in the care you receive.
I am not for one second suggesting you walk into every doctors office smiling and
rhyming of your history and symptoms rapid fire. Instead when I refer one of my
patients to another specialty I try to coach them a little regarding getting the best
outcome from the up coming meeting.
First and foremost make it clear you are there because you want to get better and
return to as normal and full a life as possible. You won’t believe how motivating an
effect this will have on the clinician to go above and beyond. Never for get they too
are human, …..well most of them.
Before you go head to your appointment get an idea of the history and symptoms clear
in your mind, better still on paper. General medical history not directly relating to
your condition may be very important that why you’re seeking their help not GOOGLE.
Listen carefully to their questions and reserve your possible frustration and
judgement until later. I had a patient just two days ago who was aggressively
confrontational from the moment I walked in the room demanding to know why I didn’t
have my walls decorated with certificates and diplomas to reassure them of my
professional abilities. After 10 minutes and several deep breaths we finally got
around to discussing her health problem.
By all means question, investigate and become informed about what you believe your
condition to be, YOU are your own best advocate.
Remember medical specialists are human and will be influenced by you, both positively
and negatively. They are trained to deal with nervous, anxious and frightened
They have however only one hardwired response to a motivated engaged patient, and
that is to HELP!
Orthotics may just have become sexy!
I think we’ve got something very exciting coming for our female patients presently wearing orthotics! In the next week or two our patients presently wearing a current orthotic prescription they are comfortable with can come in and size their feet for a range of custom made sandals and footwear from which they can choose colour and style. These will be custom made with your unique prescription orthotic milled into the footbed. To see the full lineup of styles follow the link to https://integrityortho.com/custom.../custom-footwear.html
Its not by accident that we have pharmacies next door to our offices. We write prescriptions and recommend products all the time to our patients. As a general rule we have chosen not to retail products in our offices. It’s is however important to have a great pharmacy close by where our patients will have a good choice of products and receive great service and the best pharmacological advise. Terrace Hill Pharmacy in Brantford and Kingsbridge Pharmacy in Mississaga offer our patients just the care they need. We are very grateful for the clinical knowledge and support that both these pharmacies have provided over many years.
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