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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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case study no 4
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
what are our objectives
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.
u d plantar cover replaceable
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
to make a replaceable pad
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.
case study no 5
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).
what are our objectives9
What are our objectives?
  • Reduce pain
  • Prevent recurrence
  • Remediate/ remove the cause
    • Footwear
    • Exostosis
interdigital silicone wedge
Interdigital Silicone Wedge
  • Cushions the exostosis
  • Keeps the involved toes apart
  • 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.
to make a silicone device
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.
along with
Along with…
  • Changing footwear
    • Lower heel
    • Strap across toe box or wider toe box
  • Possible surgery
    • Excise exostosis
case study no 6
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.
what are our objectives17
What are our objectives?
  • Reduce pressure
  • Alter footwear
  • Redistribute forces/ cushioning
  • Offer comfort
  • Maintain tissue viability
  • Ensure education/ inspection
hallux valgus crescent in rolofoam
Hallux Valgus Crescent in Rolofoam
  • Easy to use & can be washed
  • Long life
  • Patient must be able to use
  • Encourages self-inspection
along with19
Along with…
  • Footwear
  • Education
case study no 7
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
what are our objectives21
What are our objectives?
  • Enhance comfort
  • Reduce recurrence of the apical HK
  • (As deformity is fixed unable to alter structure)
toe prop
Toe prop
  • Provides cushioning to apices of digits.
  • Reduces weightbearing contact and pressure over the apices of the digits.
along with23
Along with…
  • Scalpel debridement of HK
  • Increase depth of toe box in shoes
homework task
Homework Task…
  • Review your notes, lectures & videos on Padding & Strapping
  • 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.