Hi, this is Dr. Silvester and I’m going
to talk today a little bit about ulcers on the end of the toes and patients who have
diabetes and other forms of neuropathy. I just happen to have a patient here who came
in today with a little pain on the end of her toe. It’s not an ulcer but it’s close.
You can see that there’s a nice callus right on the end of it. This callus forms because
of the position of the toe. If I load her foot, and look the way her toe bends, the
end of the toe is the weight-bearing surface. You can see that this toe is bent and the
end of the toe is hitting the ground. She would be a really good candidate to undergo
that procedure, and literally in two days she’d be back in shoes, doing everything
she wanted to do, because it’s about the same amount of trauma as an injection. If this toe is reducible – if you can take
the toe and straighten it out, which you can in her case, and even if it isn’t all the
way reducible, there’s an exciting new procedure that we do, where we use just a needle on
the bottom of the toe to lengthen the tendon. We just fenestrate the tendon and the toe
relaxes and goes straight. Once she fires or flexes her tendons, this
toe curls more than all the rest of them, and she gets this little callus on the end.
This toe is going to require a little different procedure, but we just want to fix this because
she’s getting this callus here, she’s tried lots of different things to get rid
of it, and it still hurts her. This is the procedure. We just put little holes in the
tendon. Ok – now curl your toe. Hold it down, very
good, now stay right there. We just do this until the toe doesn’t curl
as much. Now, see the toe doesn’t curl as much and
it’s easily reduced. That’s been released, the tendon’s been lengthened, and this won’t
have that callus on the end. In this patient, you get concerned that these other toes may
bother her someday, but all we’re dealing with today is trying to show the technique
of how to get that done, and how to make that toe so it doesn’t grip so hard and this
callus goes away. There’s a closeup of the wound. you almost don’t even need a dressing
on it. By fixing the position of the toe, you can
get rid of things like this callus and this ulcer and significantly lower the risk of
a foot ulcer in patients who have neuropathy or diabetes.
Thanks for listening!