https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/199 Thu, 20 Apr 2017 11:20:55 +0000 A case of amputation of the fourth toe is described in a diabetic patient. The patient had overlapping of third and fourth toes since her childhood and later she developed soft lipomas over the fourth toe and lateral aspect of the dorsum of the foot. The lipomas were excised without relief of pain. Subsequently, the fourth toe was disarticulated with relief of pain and healing of ulcers. The role of prophylactic amputations in such cases is described. Address for Correspondence:Dr Faria Afsana, Preventive Foot Care Unit, BIRDEM, 122 Kazi Nazrul Islam Avenue, Dhaka, Bangladesh. e-mail: fariaafsana@yahoo.com       Radiological examination revealed that there were expansion and deformity of right 3rd and 4th toe with osteophytosis. Fig-2. X-Ray of the Foot After all these clinical examination and radiological findings she was advised to maintain a posture with mechanical devices so that the 2nd, 3rd, 4th toes were kept separated. On trying to keep the toes apart they become very much painful. She consulted a surgeon. The surgeon identified several subcutaneous lipomas in the flexor tendon of 4th toe and these were excised and removed to relieve overlapping 4th on the 3rd. Fig-3. After tendon excision   Gradually the friction site of the 3rd toe totally healed. The size of callus reduced and eventually it was no more detectable. Her gait started normalizing with the decreasing intensity of pain to a stage of completely pain free. Now, she is in regular follow up in foot care unit, BIRDEM wearing shoes of same size in both feet. Fig-5. Two weeks following Surgery Discussion   Bony deformities increase the risk of foot ulceration. Deformities lead to bony prominences, areas of high-localized pressure and total weight bearing area of foot is reduced. The overlying skin is subjected to high mechanical pressure. Deformities should be recognized and treated early to avoid callus and foot ulcer.5 Foot care education is an integral component of diabetes management. Proper education about foot care and warning signs of foot can save a foot from serious complications. Acknowledgement   1.   Gibbons G, Eliopoulos GM. Infection of the diabetic foot. In: Kozak GP et al., eds. Management of diabetic foot problems. Philadelphia: Saunders, 1984; 97-102. 3.   American Diabetes Association. Preventive foot care in people with diabetes. Diabetes Care 2000;      23(Suppl 1): S55–6. 5.   Pendscy S. Deformities. In: Diabetic foot: A Clinical Atlas, 1st ed, New Delhi, Jaypee Brothers Medical Publishers (P) Ltd 2003; 53-57. 2026 Ibrahim Medical College. All rights reserved.