I first met Carl back in 2008 when he originally came to be casted for a pair of orthotics when he had his left great toe amputated a year earlier. He told me that the summer before sitting in my office, he had on a pair of crocs that caused the skin on his left heel to peel off and blister. This blister then turned into an ulceration. A second blister then turned ulceration began to develop on his left great toe. He had a lady that claimed to clean feet come in and began working away on his feet. As she was going through her cleaning procedure, Carl had noticed that the tools she was using were not coming out of packages that were guaranteed they were sterilized and just didn’t seem to look clean to him. He soon found out that his gut feeling was true and he learnt that he had developed a staphylococcus infection in his left great toe. This staph infection lead to his first amputation of his left great toe. So when I had originally seen him, he had only the left great toe missing. Now, typically a staphylococcus infection can be treated with heavy doses of antibiotics but because Carl did have diabetes and very poor circulation to his lower legs, this was the reason why he originally developed the ulcerations which lead to the staph infection.

Upon my assessment, these were my findings:

Non weight bearing

• Left great toe amputated
• Right plantarflexed first ray
• Pes Equinous
• Right dropped metatarsal heads
• Right valgus forefoot

Weight bearing

• Neutral Knee Alignment
• Pes Cavus
• Bilateral Varus rearfoot
• Mild midfoot supination

Gait Analysis

• Initial bilateral lateral heel strike with mild supination during midstance
• Normal right subtalar resupination during toe off and left steppage through toe off due to the absence of the left great toe.
• Carl was casted for a pair of custom made foot orthotics with a questionable toe filler to replace the area of the left great toe. Once the orthotics were fitted into his shoes, a toe filler was not needed at this time for him.

10 months later in 2009, Carl comes walking back into my office. He came this time with a note from his surgeon stating that he now had his 2nd and 4th left toes amputated. The staph infection had found its way into these two lesser toes and amputation was Carls only option.

This time when I completed my assessment, less was noted on the left foot because now there were only 2 toes left. One extremely noticeable development that stood out was that the foot was becoming more extremely cavus almost causing the foot to look like it was shrinking. His size 10 shoes that he was wearing were now too big on his left foot. After completing my second assessment on Carl, this next pair of orthotics a toe filler now had to be placed on the left orthotic to fill the toe box of his left shoe. Without this toe filler, Carl’s gait was stunted on the left because he could not toe off. When the second pair of orthotics were placed in his shoes and I asked him to walk in them, the first thing both Carl and I noticed was that he could toe off to some degree on the left that allowed for a more fluid gait cycle.

Two years have gone by since I last saw Carl and just the other day he came walking back into my office. Not only was he doing very well with his orthotics, he wanted to be casted again for another pair so that he could have that newer pair placed into a new pair of shoes he had bought. On his left foot, there is no sign of any type of infection. The foot looks healthy for the loss of three toes and without the support of his orthotics with the toe filler on the left orthotic, Carl would not be able to ambulate and carry on with his daily activities. He was casted for a new pair of orthotics with a toe filler, placed in his new shoes and is able to carry on with his life’s routine.