Abstract
BackgroundArthritic toe pathologies frequently lead to the development of painful apical pressure skin lesions that can compromise gait and affect quality of life. Historically conservative treatments involve the use of a toe prop with the intended aim of reducing plantar pressure from the apex of the digit. However, the effect of toe prop treatment on plantar digital pressure has not been investigated.MethodTwenty two subjects were recruited with lesser digital deformities and associated apical skin lesions. Individual pressure sensors were placed on the apices of the lesser toes and pressure was recorded under three toe prop conditions (leather, gel and silicone mould). A modified comfort index was utilised to assess the comfort of each condition.ResultsSignificant difference (p < 0.05) in mean peak pressure was observed at the apex of the 2nd toe when using the gel (p < 0.001) and silicone (p < 0.001) toe prop compared to no toe prop. There was also a significant difference in the mean pressure time integral at the apex of the 2nd toe when using gel (p < 0.001) and silicone (p < 0.004) toe props. There was no significant correlation between comfort and the recorded peak pressures. However, there was an indication that the silicone toe prop was more comfortable.ConclusionAs compared to the leather and silicone mould toe props, gel toe props were found to be the most effective for reducing peak pressure and pressure time integral on the apex of the second digit in patients with claw or hammer toe deformity.
Highlights
Arthritic toe pathologies frequently lead to the development of painful apical pressure skin lesions that can compromise gait and affect quality of life
The silicone toe prop reduced mean peak plantar digital pressure compared to no toe prop condition for sensor 1 only, sensor 2,3 and 4 recorded higher mean peak plantar digital pressure
The results from this study highlight a significant reduction in peak plantar digital pressure and plantar digital pressure time integral on the apex of the second digit for the gel and silicone toe prop conditions
Summary
Arthritic toe pathologies frequently lead to the development of painful apical pressure skin lesions that can compromise gait and affect quality of life. Toes play an important role in dynamic foot function by increasing the weight bearing area of the forefoot This increased area allows for sufficient plantar pressure to be exerted over a fixed point from which the body can be propelled forward [1,2]. The development of painful arthritic toe pathologies occurs over a long period of time, where alterations in propulsion can change joint positions. This can lead to pressure related skin lesions that compromise gait and can affect quality of life [5]. Digital deformities in the sagittal plane include claw, hammer, retracted and mallet toes. A hammered toe involves hyperextension of the MTP Joint and a flexion deformity of the proximal IP Joint, there is no flexion deformity at the distal IP joint [6-8]
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