Upon reflection, I’m not quite sure why it’s taken me so long to blog about this particular condition. It’s by no means rare or unusual, and the pain from the condition can cause sane individuals to want to perform insane acts.
A patient this morning arrived with a terrible tale of agony ruining a fantastic once-in-a-lifetime trip to the mountains in Italy.
The source of the pain resides between the 4th and 5th toes of the right foot with the 4th toe being extremely sensitive throughout.
An initial misdiagnosis compounded this issue, resulting in the lesion being treated as plantar wart with a variety of caustics, leading to a tissue breakdown, maceration and subsequent minor infection.
From the picture above, the primary lesion is on the 4th toe, with an associated lesion on the 5th toe. The key to the formation of these lesions is the foot function, or more precisely the disfunction.
The “soft corn” forms due to pressure caused by the bony prominences of the adjacent toes pressing against each other in a moist environment.
But! I hear you say, With the foot non-weight bearing, the two lesions don’t touch each other, and their associated bony “sticky out bits” don’t line up to rub ! Explain yourself!
Ok to explain, a very quick biomechanics lesson. There are three primary muscles responsible for controlling the amount our feet pronate (roll inwards). One of those is called Flexor Digitorum Longus (FDL). The more the foot pronates, the greater the pull on FDL and the more contracture or curling in the toes.
The more the foot pronates, the greater the pull on FDL and the more contracture or curling in the toes.
Because of the angles at which FDL approaches each toe, the pull changes progressively from 1st to the 5th toe. The effect on the “wee piggie” is to curl the toe sideways into its neighbour and not straight down, as we can in the 2nd toe.
Now our task is to identify the source of the instability, and ideally, that will begin with video gait analysis. Occasionally, the condition is so debilitating that it’s necessary to effect a surgical correction prior to treating the underlying cause. Regardless of where you may be on the scale of severity, the first step is a proper diagnosis, explanation and a full appraisal of the options available.
If you have enjoyed our past blogs and videos over the last year and beyond, then like and subscribe to our Facebook or Instagram feeds. We love when you share our blog, more people need to be exposed to good factual information without bias or self-interest. We will be updating them with a steady stream of new educational and informative subjects. Any subjects you would like us to write about then please send suggestions. We are easy to get hold of through any of our social media outlets or directly through our website @ www.podiatryassociates.ca
