This patient visited us and wanted to opt for surgery to remove the discoloured risen lesions on the toes, we referred her to a foot surgeon. She had 2nd and 3rd toes shortened and the lesions removed. 6 months later there is no movement of the toes (they are fixed) and a dull pain in the toes is present which has been increasing progressively. Surgery is an alternative to the toe lift but certain considerations need to be taken before embarking on this option, once you remove bone you will not put it back in!
Scarring and its accompanying esthetic, functional, and psychological sequelae still pose major challenges. To date, there is no satisfactory prevention or treatment option for hyper trophic scars on the tops of toes, which is mostly due to not completely comprehending the mechanisms underlying their formation. However, providing footwear advice is the most logical prevention option but this may not balance with the individuals needs and desires. A predominant role in hypertrophic scarring prevention and treatment still remains silicone sheeting or gel. The efficacy and safety of this gold-standard, non-invasive therapy has been demonstrated in many clinical studies, but to date, exact mechanisms by which they improve hyper trophic scars are yet to be fully agreed upon. Second most validated and more specialised scar treatment is intralesional corticosteroid injections, especially in combination with other therapeutic modalities. Current therapeutic approaches with their empi
If a scar forms, regardless of whether or not prophylactic measures were applied, it should be evaluated clinically. When assessing scars clinically, their size, colour, contour, height (thickness), surface area, surface texture, pliability, location, and subjective symptoms such as itching and pain, and also patient’s perception should be taken into account. It has been indicated that this subjective component of the patient’s view of the scar is as important as objective aspect and it may be very influential in determining the patient’s quality of life (1). Assessment of the scars is a frequent topic of discussion among clinicians because there is no generally accepted evaluation tool, although various ones have been proposed (2). None of these, however, seem suitable as a stand-alone tool, suggesting that combination of objective imaging tools and scar scales and questionnaires (patient reported outcome measures that we use in clinic) may be justified to achieve comprehe
As part of the Toe Lift procedure we provide an aftercare package of silicone gel products. The International Advisory Panel in 2001 suggested a combination of intralesional corticosteroid injection and silicone gel sheeting for the treatment of hypertrophic scars (1). Silicone gel sheeting was first used in 1981 for the treatment of hypertrophic scarring at an Australian pediatric hospital (2). A trial involved 42 people aged between 2 and 60 with red, dark or raised scars. The trial studied the effect of Silicone gel treatment at two and six months and compared the results with untreated scars (3). Results showed 93% of scars had improved after 2 months with silicone gel. These scars had improved in condition, colour and texture, softening to enable the skin to become more flexible. Only 12% of untreated scars improved after 2 months, with just 38% showing improvement after 6 months. Another study which was probably one of the most extensive of its kind, involvi
Restylane® Skinboosters™ are outstandingly suitable for deep hydration of the skin on the tops of toes, and their effect is long-term and safe. In our society, youthfulness and beauty free of imperfections are sadly positively attributed and also determine interactions and positioning in the social as well as the professional environment (1). This statement also applies to the appearance of your feet. Injectable hyaluronic acid (HA) products can be classified into two groups with different therapeutic goals for podiatry. They can either be used for augmentation and volume substitution or as with the skin boosters which are injected superficially for the revitalization of the skin (2). The biological significance of HA for the skin as well as its excellent physicochemical properties, especially its high water-binding capacity, determine injectable HA based skinboosters for improvement of skin quality. Although native HA is ubiquitous in the human body, the largest amount i
In a world where the “beautiful” are given many advantages, it is easy to understand why appearance is weighted so highly. The old adage, “What is beautiful is good” is very still sadly true today, in fact especially today with the influence of social media, when being perceived as attractive creates a halo effect. Feet are no different then other parts of the anatomy, especially for women who tend to wear more open toed shoes and sandals then men. Measuring quality of life is an important aspect of delivering holistic dermatological care to feet. The lesions on the tops of toes are trivial to most health professionals and my fellow podiatrists, some individuals adapt to the change in the appearance of their toes, however, others react negatively and have decreased psychosocial performance (functioning of emotional, social, mental well-being). The management of scars is a challenge for professionals since these lesions can greatly impact quality of life. Although scars rare
The International Advisory Panel on Scar Management recommended the use of intralesional steroid injections for the treatment of hypertrophic scars (1). Corticosteroids were proved to induce scar regression through many different mechanisms. Firstly, they suppress inflammation by inhibiting leukocyte and monocyte migration and phagocytosis (2). Second, they are powerful vasoconstrictors, thus reducing the delivery of oxygen and nutrients to the scar bed (2). Third, they have an antimitotic effect that inhibits keratinocytes and fibroblasts, slowing reepithelialization and new collagen formation. Furthermore, they may reduce plasma protease inhibitors, thus allowing collagenase to degrade collagen. Corticosteriods also induces a significant plunge in alpha-1-antitrypsin and alpha-2-macroglobulin levels, which tend to be greater in scar tissue and are natural inhibitors of collagenase in human skin (3). Corticosteroids affect fibroblast proliferation and production capabilitie