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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 averruca overlying her 2nd MTPJ. She leads a numberof aerobics classes each week and is concernedabout the pain.

On examination:

The remains of a VP are evident overlying the L/2nd

MTPJ.

Training shoes are in excellent condition andappropriate.

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 enableADLs/employment.


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Ud Plantar Cover - Replaceable Ud to remove weight

from an area (eg. Alesion).

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 fromthe foot.

Cut your Lastonet toe strap & met. strap makingsure you dont occlude the dorsalis pedis artery nor

deform the digits.

Fit your Lastonet straps to the pads adhesivebacking.

Cover the straps and adhesive side with tape (ZnO orE.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 andmust wear metbusters. She complains of apainful interdigital Heloma Molle.

On examination:

HM b/n the R/4th & 5th toes.

On palpation there is an exostosis on themedial aspect of the head of the R/5th proximalphalanx at the IPJ (this has also beenconfirmed 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 isadded.

Catalyst promotescross-linking ofpolysiloxane chainsin the putty.

After a period of time,

flexible solid isformed.


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To make a silicone device Dont wear gloves the

putty will stick.

Ascertain the amount ofsilicone putty needed tomake the device best

to start with too much. Roll the silicone putty

into a ball and thenflatten a little in the

palm of the hand. Add enough catalyst

too little and it wont setfirm; 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 herdiabetes with some neurovascular changes evident.

On examination:

Bilateral HAV Grade 3 (based on the Manchesterscale)

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 presentscomplaining of painfullesions on the apices of histoes which is compromising

his ability to participate in hisweekly lawn bowlscompetition.

On examination: Fixed toe deformity

Apical lesions on the middlethree 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 pressureover the apices of the digits.


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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 adheredto 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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