Dear All,
A 12 year old girl recently presented for unrelated biomechanical reasons.
On examination I noticed a rather severe breakdown in the integrity of the
skin (plantar met. area). She also has minimal nails due to the same
reason. She quite proudly explained that this was due to her chewing and
tearing the skin off with her teeth. Her mother was aware of this but was
not concerned (although I was). Her hypermobility obviously assists her in
the act of chewing. I advised both patient and mother of the risks of this
habit, and strongly advised her to cease the chewing. She returned 2 weeks
later for the orthotic dispense and the situation had worsened. She now has
very large open wounds and has started at the apices of the toes also. She
acknowledges that there is quite significant discomfort associated with
this but will not stop. Occasionlally a child presents with a history of
chewing there toe nails, but this is quite extreme.
She is a healthy young girl, with no nutritional anomalies.
I suspect this is out of the podiatrists league but I told the mother I
would query other pods. Greatly appreciated if anyone has any ideas.
Shane Atkins
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