A non-surgical approach to offloading neuropathic ulcers on the distal phalanges in the presence of first ray metatarsal hypermobility.

Introduction

The standard of practice to heal neuropathic ulcers on the toes is offloading by reducing the amount of pressure on the wound. (Crawford & Fields-Varnado, 2012). Once healed the patient wears custom insoles to prevent new wounds. (Crawford & Fields-Varnado, 2012). We found some patients will not stay healed despite wearing therapeutic footwear.  In the healthy foot each step places the body’s weight on the first metatarsal head. The metatarsal is locked into a downward plane placing the patient’s weight on the metatarsal head and not the hallux. With hypermobility the first metatarsal head elevates instead of locking into the cuneiform bone. The weight, intended for the metatarsal head, transfers to the hallux were a wound forms. (D’Amico, 2016). Our intervention is for distal phalanges wounds with first ray metatarsal hypermobility.

Purpose

To devise a way to prevent and offload neuropathic foot ulcers on the distal phalanges in the presence of first ray metatarsal hypermobility.

Intervention

We secure a tampon on the plantar surface of the proximal interphalangeal joint. The firm tampon structure buttressed the proximal phalanges locking the metatarsal into the cuneiform bone thereby preventing hypermobility. The weight is then correctly placed on the metatarsal head instead of the hallux.

Conclusion

Using a tampon as a buttress is an effective non-surgical intervention for patients with first ray metatarsal hypermobility to prevent and offload neuropathic hallux ulcers.