Its amazing how something as simple as a small ulcer under the big toe joint can limit your mobility and quality of life. Quality of life is a term we chuck out there easily but when talking to this patient it really was far reaching. On a daily basis wound care was taking at least 20 minutes to perform, moving within her home was painful thus kept to a minimum and planned to avoid further trauma. Trips outside the house only as necessary and again consolidating appointments to one day to avoid subsequent outings. Social interactions were avoided. Going out meant more pain and little pleasure, and she didn’t want visitors entering a home that was no longer being maintained to its previous standards. Sadly, that left phone and internet communications…..so enough on that subject.
Usually shoe modifications, specialized wound care, orthotic intervention, and management of systemic illness are the mainstay we employ to address these kind of situations. All were in place and functioning, but still very little progress was made on the lesions under both 1st metatarsal phalangeal joints.
Back in late September we suggested it was time to be a little more proactive to reduce the mechanical force perpetuating these problems. To achieve that we suggested a tenotomy to the long extensor tendon of the great toe. The beauty of this procedure is that the small incision is not weight bearing, heals very quickly and beyond the day of the procedure does not require immobilization nor do we need to modify the existing orthotics and or footwear.
So 5 weeks later we are now addressing the left hallux at the patients urgent request. The right lesion has remained healed since the first post operative visit and the tissue is returning to a more normal appearance with little evidence of scar tissue. Best part of this is that the patient is now back playing darts twice a week and can’t wait for the left toe to follow suit and heal as well.
So nice to see and hear her positivity and joy at everyday life events and even if hitting the triple 20 still remains illusive (darts joke).
As with so many of the procedures we perform the surgery is simple, its the patient selection that requires careful evaluation.
Schedule an appointment at an office location near you with one of our dedicated specialists. We do not require a referral however pertinent information from your primary care specialist may help in our diagnosis. Bring any pertinent images (X-rays) or test results with you and if appropriate samples of your footwear. Given the nature of our specialty it is likely we will want to observe you standing or walking during the initial exam.
Call The Podiatry Associates in Mississauga, at (905)568-3800. We are also located in Brantford, ON, at (519) 751-2900 and Whitby, Ontario, at (905) 433-0200