title: A pilot study investigating the utilization of crest pads for treatment of toe callus and ulceration.
abstract: Patients with lesser-toe deformities are at increased risk of developing calluses and ulcers on the distal ends of the affected digits because of the increased pressures applied to these areas. The number of diabetic patients in the United States continues to increase, along with associated comorbidities such as peripheral vascular disease and peripheral neuropathy. These conditions predispose patients to developing foot ulcerations, especially if foot deformities are present. Crest pads are a simple-to-make, inexpensive option to treat calluses and ulcerations on the distal ends of digits; however, there is no research available that support their use. Crest pads consist of rolled gauze covered in moleskin, with a large opening that fits over several toes and lies on the dorsal aspect of the foot, with the padded portion resting under the toes. Over several days of use, the pad molds to the plantar aspect of the toes, offloading pressure from the distal end of the affected digit(s). The sample was obtained through a retrospective chart review of patients identified as having had at least one nail care visit and at least one follow-up visit at a vascular surgery practice between August 2011 and December 2014. Potential subjects with toe deformities who presented with callus or ulcer on the distal end of a digit were considered for inclusion, if they received a crest pad as part of their treatment plan. The scholarly project was a preintervention or postintervention design with subjects acting as their own controls. McNemar's test was used to analyze the results which were statistically significant (P < .0001 at first callus follow-up and P = .0002 at second callus follow-up) for callus, hemorrhagic callus, and/or ulcer improvement following the crest pad intervention. The results of this scholarly project support the use of crest pads in patients with lesser-toe deformities to treat distal toe calluses and/or ulcerations.
authors.affiliation: LVPG Vascular Surgery, Allentown, Pennsylvania. Electronic address: meloinc@ptd.net.
authors.forename: Monica
authors.initials: M
authors.lastname: Melo
authors.affiliation: DeSales University, Center Valley, Pennsylvania.
authors.forename: Tricia
authors.initials: T
authors.lastname: Bernecker
authors.affiliation: LVPG Vascular Surgery, Allentown, Pennsylvania.
authors.forename: James
authors.initials: J
authors.lastname: McCullough
authors.affiliation: Department of Surgery, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Hong
authors.affiliation: Department of Surgery, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania.
authors.forename: Jane Scott
authors.initials: JS
authors.lastname: Trumbauer
authors.affiliation: DeSales University, Center Valley, Pennsylvania.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Miller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications; D017719:Diabetic Foot / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications; D010865:Pilot Projects; D011312:Pressure / Q000009:adverse effects; D012189:Retrospective Studies; D014034:Toes; D014481:United States