Patient with recurrent ulcer on the big toe

ipj ulcer1 ipj ulcer2Here is an x-ray and picture of a patient of mine.  He had a surgery that was done to remove the joint in the big toe as you can see above.  This usually helps wounds from stop coming back.  However, in this case the toe was quite swollen after the surgery and the patient was wrapping the toe with a material called coban to get down the swelling.  As a result of this wrap, the swelling and the way he walks this ulcer came back.  He has in his large joint a condition called hallux lmitus where the great toe joint does not bend and all the movement happens at the little joint (IPJ) of the great toe.  This can be difficult to treat.  At this time I am trying to restrict the movement of the joint with a rigid extension on his orthotic that will go under this toe.  If that doesn’t work maybe another surgery is needed.