A Novel Method to Offload Neuropathic Ulcers of the Distal Phalanges in the Presence of First Ray Metatarsal Hypermobility: 3 Case Reports.

Document Type


Publication Date


Publication Title

Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society / WOCN


washington; seattle; swedish


BACKGROUND: The standard practice to heal neuropathic ulcers on the toes is to offload the affected areas with special types of therapeutic footwear including shoes and boots to reduce the amount of pressure on the wound. Once healed, the individual wears custom insoles to prevent the development of new wounds. In our practice, we found that some newly healed wounds will reulcerate despite wearing therapeutic footwear. We devised a method to prevent and offload neuropathic foot ulcers on the distal phalanges in the presence of first ray metatarsal hypermobility, a common problem associated with the development of wounds.

CASES: Three individuals with first ray metatarsal hypermobility and recurrent neuropathic ulcers demonstrated healing using a buttress constructed from a tampon placed under the plantar surface of the proximal interphalangeal joint. The buttress was successful in supporting the first ray metatarsal to keep it in proper alignment.

CONCLUSION: We found using a buttress was an effective nonsurgical intervention for these 3 individuals with first ray metatarsal hypermobility to prevent and offload neuropathic hallux ulcers.