What is the plan of care for a patient with great toe overlapping or pressing into the 2nd toe (second toe)?

Management of Great Toe Pressing into Second Toe

For a patient with a great toe overlapping or pressing into the second toe, the most effective plan of care involves appropriate footwear selection with adequate toe box width, along with possible orthotic devices to realign the toe position.

Assessment and Classification

When evaluating a patient with a great toe pressing into the second toe, consider:

• Degree of deformity (flexible vs. rigid)
• Presence of pain or discomfort
• Evidence of skin irritation or callus formation
• Footwear habits
• Underlying biomechanical issues

Conservative Management Approach

1. Footwear Modifications

• Select shoes with adequate toe box width and depth 1
• Choose shoes with rounded toe boxes rather than pointed designs
• Ensure proper shoe length (1-2 cm longer than the foot) 1
• Select shoes with adjustable closures (laces or straps) to accommodate dressings if needed 1
• Avoid tight-fitting shoes that compress toes 1

2. Orthotic Interventions

• Toe spacers between the great toe and second toe
• Custom-molded insoles to redistribute pressure
• Silicone toe sleeves to reduce friction and pressure
• Toe alignment splints for nighttime use

3. Skin and Nail Care

• Regular assessment for areas of hyperkeratosis (callus) formation 1
• Professional debridement of any calluses by a podiatrist 1
• Application of emollients to prevent skin dryness and cracking 1
• Proper nail care with straight-across trimming to prevent additional pressure 1

Advanced Interventions

If conservative measures fail to provide relief, consider:

1. Podiatric Referral

• Assessment for custom orthotic devices
• Evaluation of biomechanical factors contributing to the deformity
• Professional debridement of calluses and hyperkeratotic tissue 1

2. Surgical Options (for severe cases)

Surgical intervention may be considered for persistent, painful deformities that don't respond to conservative management. Options include:

• Soft tissue procedures (tendon transfers, capsular releases)
• Osteotomies to realign toe position
• Arthroplasty or arthrodesis for fixed deformities 2

Special Considerations

For Diabetic Patients

Patients with diabetes require special attention due to increased risk of complications:

• More frequent foot assessments
• Immediate attention to any skin breakdown
• Properly fitted therapeutic footwear with pressure redistribution 1
• Regular podiatric care as part of comprehensive diabetes management 1

For Patients with Peripheral Arterial Disease

• Vascular assessment before any surgical intervention
• Careful monitoring of skin integrity
• Conservative approach to avoid tissue damage 1

Monitoring and Follow-up

• Regular assessment of toe position and skin integrity
• Evaluation of footwear fit and condition
• Adjustment of orthotic devices as needed
• Patient education on proper foot care and early recognition of problems

Common Pitfalls to Avoid

1. Ignoring the condition until significant pain or skin breakdown occurs
2. Using adhesive tape or highly adhesive padding that may damage skin
3. Attempting "home surgery" or aggressive self-treatment
4. Continuing to wear inappropriate footwear despite symptoms
5. Failing to address underlying biomechanical issues

The key to successful management is early intervention with appropriate footwear and orthotic devices, along with regular monitoring and professional care when needed.