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Padding Strapping Lecture II

You have been using cryotherapy to aggressively treat a verruca overlying her 2nd MTPJ. ... his ability to participate in his weekly lawn bowls competition. ...

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Padding Strapping Lecture II

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  1. Padding and Strapping Part II

  2. Case Study No. 4 • Miss A is a 35 year old fitness instructor. You have been using cryotherapy to aggressively treat a verruca overlying her 2nd MTPJ. She leads a number of aerobics classes each week and is concerned about the pain. • On examination: • The remains of a VP are evident overlying the L/2nd MTPJ. • Training shoes are in excellent condition and appropriate. • Pain on palpation of the L/2nd MTPJ region

  3. What are our objectives? • Treat necrotic lesion with cryotherapy to remove the VP. • Ensure maintenance of tissue vitality for healing. • Redistribute weight from area. • Provide comfort & reduce pain to enable ADLs/employment.

  4. U’d Plantar Cover - Replaceable • U’d to remove weight from an area (eg. A lesion). • Replaceable form • Durability/ longevity • Ease of use • Reduces sweat absorption • Patient is young & flexible • Patient has appropriate footwear

  5. To make a replaceable pad… • Cut and shape the pad desired – remember to cut the pad so that the adhesive backing is facing away from the foot. • Cut your Lastonet™ toe strap & met. strap making sure you don’t occlude the dorsalis pedis artery nor deform the digits. • Fit your Lastonet straps to the pad’s adhesive backing. • Cover the straps and adhesive side with tape (ZnO or E.A.P) to secure straps and to protect pad.

  6. Case Study No. 5 • Ms. K is a 49 year old sales assistant at David Jones. She is on her feet all day and must wear metbusters. She complains of a painful interdigital Heloma Molle. • On examination: • HM b/n the R/4th & 5th toes. • On palpation there is an exostosis on the medial aspect of the head of the R/5th proximal phalanx at the IPJ (this has also been confirmed on x-ray).

  7. What are our objectives? • Reduce pain • Prevent recurrence • Remediate/ remove the cause • Footwear • Exostosis

  8. Interdigital Silicone Wedge • Cushions the exostosis • Keeps the involved toes apart

  9. Silicone • Putty or paste form to which a catalyst is added. • Catalyst promotes cross-linking of polysiloxane chains in the putty. • After a period of time, flexible solid is formed.

  10. To make a silicone device… • Don’t wear gloves – the putty will stick. • Ascertain the amount of silicone putty needed to make the device – best to start with too much. • Roll the silicone putty into a ball and then flatten a little in the palm of the hand. • Add enough catalyst – too little and it won’t set firm; too much and it will set very quickly.

  11. Along with… • Changing footwear • Lower heel • Strap across toe box or wider toe box • Possible surgery • Excise exostosis

  12. Case Study No.6 • Mrs M is 75 year olds and has had NIDDM for 15 years. She maintains reasonable control of her diabetes with some neurovascular changes evident. • On examination: • Bilateral HAV Grade 3 (based on the Manchester scale) • Exostosis/ bunion on the medial aspect of the B/1st MTPJs. • A preulcerative area appears to be developing over the exostosis/ bunion.

  13. What are our objectives? • Reduce pressure • Alter footwear • Redistribute forces/ cushioning • Offer comfort • Maintain tissue viability • Ensure education/ inspection

  14. Hallux Valgus Crescent in Rolofoam • Easy to use & can be washed • Long life • Patient must be able to use • Encourages self-inspection

  15. Along with… • Footwear • Education

  16. Case Study No. 7 • Mr B is an active 80 year old gentleman who presents complaining of painful lesions on the apices of his toes which is compromising his ability to participate in his weekly lawn bowls competition. • On examination: • Fixed toe deformity • Apical lesions on the middle three digits of B/F

  17. What are our objectives? • Enhance comfort • Reduce recurrence of the apical HK • (As deformity is fixed unable to alter structure)

  18. Toe prop • Provides cushioning to apices of digits. • Reduces weightbearing contact and pressure over the apices of the digits.

  19. Along with… • Scalpel debridement of HK • Increase depth of toe box in shoes

  20. Homework Task… • Review your notes, lectures & videos on Padding & Strapping • http://www.latrobe.edu.au/podiatry/podclinicalskills.htm • Manufacture a plantar cover (that would be adhered to the foot) • Consider the borders of the pad • Medial & Lateral • Proximal & Distal • Consider the bevelling required at each border • Single or Double? • Bring your finished product along to your practical session next week.

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