Callus On Tip Of

In the case of claw toe deformity of the second toe, callus formation and onychodys-trophy was due to exposure of the tip of the toe to high pressure during the propulsion phase of gait.

A purulent discharge was evident after removal of the callus (Figure 8.1). The patient felt no pain or discomfort due to severe peripheral neuropathy. No other signs of infection were present on the toe or the forefoot, therefore drainage of pus was adequate, and no further treatment was needed. Appropriate footwear was prescribed.

Keywords: Soft tissue infection; claw toe; onychodystrophy; subungual hemorrhage; third ray amputation

A 66-year-old female patient, with type 2 diabetes which was diagnosed at the age of 51 years was referred to the diabetic foot clinic for chiropody treatment. On physical examination she had severe peripheral neuropathy, and bounding pedal pulses. Superficial vein dilatation on the dorsal foot, dry skin — as a result of neuropathy— and hyperkeratosis over the fifth metatarsal head were noted. Painless hyper-keratosis was seen over the dorsal aspect of the left little toe, caused by inappropriate footwear. After callus removal a purulent discharge was noticed (Figure 8.2). A coagulase-negative Staphylococcus aureus was isolated from the pus. A plain radiograph was negative for bone involvement. No antibiotic was given since the pus had drained completely. The ulcer healed within 2 weeks after local treatment.

Figure 8.1 Purulent discharge was evident after removal of callus from the tip of this second claw toe with onychodystrophy. A third ray amputation was carried out 2 years ago. A subungual hemorrhage due to intense trimming of the nail of the fourth toe can be seen

Figure 8.1 Purulent discharge was evident after removal of callus from the tip of this second claw toe with onychodystrophy. A third ray amputation was carried out 2 years ago. A subungual hemorrhage due to intense trimming of the nail of the fourth toe can be seen

Fifth Ray Amputation
Figure 8.2 Superficial vein dilatation can be seen on the dorsal foot along with dry skin and hyperkeratosis over the fifth metatarsal head. There was painless hyperkeratosis over the dorsal aspect of the left little toe. After callus removal purulent discharge was noted

Non-limb-threatening infections are usually caused by gram-positive cocci, typically Staphylococcus aureus and Streptococcus spp. In hospitalized patients with diabetic foot infections, methicillin-resistant Staphylococcus aureus as well as entero-cocci are more prevalent.

Keywords: Infection; callus, claw toes

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