DIAGNOSIS:     Foot deformities

PRESENT ILLNESS:     This is a 76-year-old man who was admitted because of a painful deformity of the left foot. He had severe deformities of his feet, which had been treated in 2000 with a left foot first MP joint fusion, and correction of hammertoes. These wounds had become infected and finally heeled with a varus deformity of the MP joint. The second toe was riding under the first toe. He had undergone total knee surgeries in 2001 on the left and in 2002 on the right. His compliant now was pain in the left foot whenever he would walk and also some pain at night in the second toe and forfoot. He says he could walk about with two crutches about 150 feet. I recommended correction of the severe deformity of the second toe to prevent ulceration later. He had been treated for a bowel obstruction in 1995 with good results. His only medication is occasional Motrin for foot pain.

PHYSICAL EXAMINATION:     Both knees had motion from 0-120 degrees and were stabel, well aligned. The left first MP joint had a 45-degree hallux valgus deformity. The second toe was completely under the first toe. There was tendeness under the left third and fourth metatarsal heads. There were good pulses and good sensation in his feet. The right foot had a fixed flat foot deformity. When he was first seen in the clinic, his feet were very dirty, but when he returned before surgery, he had been keeping his feet clean.

LABORATORY DATA:     Laboratory studies showed hematocrit of 46%, white cell count of 5,700. Blood sugar was 112. The electrolites were normal and urinalysis was normal.

HOSPITAL COURSE:     In surgery on April 24th, the previous angulated fusion of the first MP joint was taken down and revised in a mild valgus position and moderate extension. The distal half of the second toe was amputated. There was some varus deformity of the lateral three toes, but not enough to require any surgical treatment. He tolerated this well with a spinal anesthetic. The dressings were changed on April 25th. The wounds were satisfactory. I applied an above ankle length cast which extended out passed the toes. He was to put light weight on the cast with a walker. He has been using crutches for years because of his foot. He was well enough to go home with a bedside commode. Discharge medicines were Tylenol.