seems that the sun begins to warm up after spending 6 months of almost continuous rain.
Good weather is a good ally of hyperhidrosis and more in adolescents with overuse of some breathable footwear. That is the cause of the next image, in which the symptoms that lead to the consultation are maceration, pain on a long time to rest and bromhidrosis.
epithelial surface grooves, produced by macerating hyperhidrosis, little breathable footwear and being a teenager, a typical clinical picture of a keratolysis puntacta. other hand, we have what may be the effects of the crisis, to extend the trimming a few months (or more than some) until you can not walk.
Al delaminate hole but did not slough it is appreciated that performing a thorough cleaning see the actual size that reaches the bone, leaving this visible and touched with the instruments. Oral antibiotic 1 week download and cures area daily. Recently are emerging and many patients with pain sesamoiditis the 1 st MTP joint, and all I have diagnosed with hallux limitus, more or less limited. One of them, a patient round the 6 decades of life, who has used safety shoes all his life, MTF has a mobility of 20-30 ° and a chronic sesamoiditis 5 years of evolution. The treatment has several concerns me. At this age and bone that limitation, we will not get any better with 30 ° max. is not sufficient for effective progress, hence the sesamoids are involved. To reduce the symptoms of the sesamoids should be "splinted" the MTPJ. It has been cut out of the area, damping wedge retrocapital, NSAIDS, etc etc but the improvement has been very low. Was performed an Rx to assess whether hypertrophy of the sesamoids and if conservative treatment does not work to start thinking about surgery. In hallux limitus
also a young girl, but in this case the mobility of 1 radio is within the physiological, but more decreased in the other foot. The deceased, an asymmetry that favors the pronation of the foot and especially the daily use of dancers, a shoe that prevents dorsiflexion of the proximal phalanx and hallux limitus causes.
The hallux limitus is associated with neck pain and back pain (Dannamberg) which presents this patient.
plantar orthoses would be the solution, but the first step is to change the footwear or use it as little as possible, exercise and use the MTP joint kinetic wedge that I have done.
With dynamic kinetic wedge left him fibular sesamoid pain as favoring the dorsiflexion of the proximal phalanx, this wheel more easily and allows the 1 st metatarsal sesamoid fall to be and perform their physiological function.
On the other hand a patient with pain in the ankles, knees, posterior tibial enthesitis who came because he said he had flat feet, diagnosed as a child. The examination conducted
can see a huge limitation of dorsiflexion hip due to a short or contracture isquitotibiales and posterior chain.
performing pronation and excess weight tissue produces a stress level of the posterior tibial insertion and ankles. It proved to walk with a wedge supinating and these pain subsided.
flat foot, was not so, but had a right foot dorsiflexed first ray and structured so that the subtalar joint of the pronated foot continuously to support the whole forefoot contact with the ground. It also has a 5-second radio plantarflexion in one foot.
In the other foot has a supinated forefoot, where on 1 radio is structured dorsi muscle but is achieved through passive manipulation match the other metatarsals.
In the right foot I used 3 layers of resin (weighs over 100kgs), 1.9 +1.3 + midtarsal area of \u200b\u200b1.2, to allow flexibility in the forefoot, because if we put the 3 resins to get too forefoot stiffness in an area that should be flexible. Posted
performed a medial posterior filling and prevent the foot pressure center deviates medially, rather it is to divert a little to the side.
Then a short heel cushioning 3mms, increase in forefoot and metatarsal inclination to help a little to the shortening of the posterior muscles.
At the other foot. We do not need much control but we need some weight to his contention. 1.9 1.2 and 1.2 where the difference of total flexibility is evident when compared with the other brace. This also makes the area from cuneometatarsal distally using only 2 layers of resin and not 3. cut out at 5 ° to 5 ° dorsiflexed radio. In hindfoot are looking for the same functionality as the other foot. Pending a supine wedge the forefoot supinated forefoot but will be assessed after a week-proof without it. 
flat foot is does not exist. Rearfoot 
as neutral as possible even with a stop in medial to prevent pronation and deviation of center of pressure medially. 
right foot in place pending an extension cord of 1 radio 1, radio offset dorsiflexed not flexible. But wait until you try to put a week. 
The right foot shows that the brace is wider, this is because the bottom of this side has more pronation and soft tissue expansion. Molds were taken also but the 2 feet are not equal. The various "experiments" I've been doing filling in the ALI or do very, very rigid brace where the brace is hardly deformed, the results have been bad, not being borne by patients in a period of 2 months. Subsequently removing part of the inner lining has improved both the symptoms and the problem that they had consulted. In some cases it is recommended but if patients can not tolerate is not equally effective. Anyway we continue to test in cases that are necessary and that making some changes if we can get them to come to "bear."
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