Padding Strapping Lecture II - PowerPoint PPT Presentation

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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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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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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


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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 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.


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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…

  • 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.


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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/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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