Special Operations Forces Medical Handbook

5-5

available, but are not required.

Assessment:
Diagnose by clinical presentation/appearance
Differential Diagnosis - rigid toe due to traumatic osteoarthritis (hallux rigidus or limitus). Toe joint
displacement/swelling (metatarsalgia, sesamoiditis). Local toe irritation (shoe irritation in absence of defor-
mity)

Plan:
Treatment: Primary:

1. Change to a wider shoe or soft sneaker if operationally permissible.


2. Use bunion pads. Over-the-counter bunion pads come in all shapes and sizes. A doughnut hole cut
   in felt or several layers of moleskin will work as a substitute for a bunion pad.


3. NSAIDs for pain relief. Ice massage if acute presentation.


4. Arch supports and orthotics in severely pronated feet.
   Alternate: Inject 0.25 cc dexamethasone acetate (or other long acting steroid) and 0.5 cc 0.5% Marcaine
   SC just medial to the metatarsal head as a one-time temporary pain relief measure during an operation.
   Multiple injections could weaken joint structures, causing progression of the deformity. Shoe or boot pressure
   can irritate the cutaneous nerve running medially along the first metatarsal head, causing severe neuritis pain
   and making ambulation difficult.
   Primitive: Cut a hole in the boot over the bump if pain is severe.

Patient Education
General: Although these are structural deformities, changing shoe style and size may provide the most relief
in an operational setting when surgery is not an option.
Activity: Limit running for 1-2 days. If pain is severe, wear open sandals for 2 days if possible.
Medications: Motrin 800mg po tid with meals
Prevention and Hygiene: Avoid tight shoes. Wear larger and wider boots if necessary.

Follow-up Actions
Return Evaluation: 1-2 weeks
Evacuation/Consultation Criteria: Evacuation is not usually necessary. If no change with conservative
measures, refer to podiatrist or orthopedic surgeon.

NOTES: Wider boot, shoe and running shoes are most important for pain relief. Postpone surgical correction
until absolutely necessary. If deformity and symptoms are severe and conservative measures fail, elective
surgery is an option.

Podiatry: Corns and Calluses

CDR Raymond Fritz, MSC, USNR

Introduction: A callus is a thickening of the outer layer of skin, in response to pressure or friction, that serves
as a protective mechanism to prevent skin breakdown. The hyperkeratotic change for corns and calluses is
similar except a corn involves a discrete pressure spot, typically over a bone. Foot and toe deformities are
subject to higher pressures and shoe irritation. A boot may rub a hammertoe at the knuckle and result in a
painful corn. Corns may also develop between toes where two bones press together. Typical callus patterns
are seen in certain foot types.

Subjective: Symptoms
Pain history of a corn or callus in the same areas.

Objective: Signs