Padding and Strapping

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Padding and Strapping

• Part II

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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

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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.

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Ud Plantar Cover - Replaceable

• Ud 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

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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 dont occlude the dorsalis pedis artery
  nor deform the digits.
• Fit your Lastonet straps to the pads adhesive
  backing.
• Cover the straps and adhesive side with tape (ZnO
  or E.A.P) to secure straps and to protect pad.

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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).

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What are our objectives?

• Reduce pain
• Prevent recurrence
• Remediate/ remove the cause
• Footwear
• Exostosis

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Interdigital Silicone Wedge

• Cushions the exostosis
• Keeps the involved toes apart

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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.

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To make a silicone device

• Dont 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 wont set
  firm too much and it will set very quickly.

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Along with

• Changing footwear
• Lower heel
• Strap across toe box or wider toe box
• Possible surgery
• Excise exostosis

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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.

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What are our objectives?

• Reduce pressure
• Alter footwear
• Redistribute forces/ cushioning
• Offer comfort
• Maintain tissue viability
• Ensure education/ inspection

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Hallux Valgus Crescent in Rolofoam

• Easy to use can be washed
• Long life
• Patient must be able to use
• Encourages self-inspection

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Along with

• Footwear
• Education

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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

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What are our objectives?

• Enhance comfort
• Reduce recurrence of the apical HK
• (As deformity is fixed unable to alter structure)

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Toe prop

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

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Along with

• Scalpel debridement of HK
• Increase depth of toe box in shoes

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Homework Task

• Review your notes, lectures videos on Padding
  Strapping
• http//www.latrobe.edu.au/podiatry/podclinicalskil
  ls.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.