Intractable Plantar Keretosis

Bilateral foot orthoses
This 36-year-old female only has seasonal allergies. She takes birth control pills and she is an active community ambulator. She had not recently has surgery, and she does not receive physical therapy. She has not previously had orthotic management.
The patient's primary complaint is that she has significant pain and discomfort in the ball of her foot secondary to callus formation. She has, what appears to be, a IPK plantar to the 3rd metatarsal head of the left foot, which appears to be very deep and it is very painful today. She has good range of motion and good flexibility about both feet. She has mild pronation. My recommendation for her is to fabricate foot orthoses for her dress and shoes and her sport-type shoes. I have recommended that she see a foot specialist regarding evaluation of the IPK and also recommended that she might try utilizing a Dremel tool to manage the callus formation of both feet.
Fabricate bilateral foot orthoses.
Casting and measurement.

In severe cases of calluses, which usually occur on the plantar aspect (bottom) of the foot, an IPK can develop. An IPK is, in medical terminology, an

* Intractable, meaning that it will not go away,
* Plantar, meaning bottom of the foot,
* Keretosis, meaning a deep seated painful callus that usually occurs under a weight bearing metatarsal (long bone of the foot).

What Can You Do?

Some treatments you can try are orthotics, padding, massage, paraffin baths, and other conservative methods

If these methods do not relieve the problem, surgical intervention is necessary. There are many types of surgeries to employ to correct this problem. A "V" osteotomy (cutting of the bone) is the most common osteotomy for the second, third and fourth metatarsal, and an oblique osteotomy for the fifth metatarsal.

Sometimes internal fixation, pins or screws, are used to help stabilize the bones when surgery is indicated. These surgeries are usually done under a local block anesthesia, and the patient is usually ambulatory (walking) immediately after the surgery in a post operative Cast Walking Boot. The newer medications make this procedure safe and pain free, but your doctor needs to be consulted as to specific cause for the specific treatment.