Case Study

Nail in shoe

A 47-year-old man with type 2 diabetes of 9 years' duration and previous history of neuropathic ulcer, attended the orthotist for review 1 month after receiving new shoes because he was developing new callus in his mid-tarsal area where he had never previously had a problem. When the orthotist removed the ethyl vinyl acetate insole he found that a large nail had punctured the sole of the shoe (Fig. 3.2). Fortunately the insole was thick enough to prevent penetration of the skin, but the increased pressure had led to callus formation.

Key points

• Patients who check their feet and report any new problems at an early stage can abort problems

• A thick insole can prevent puncture wounds

• Patients with neuropathy are wise to check the soles of their shoes for penetrating nails.

Fig. 3.2 Nail has penetrated the sole of the shoe—the insole has been removed to reveal the nail.

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