Escolar Documentos
Profissional Documentos
Cultura Documentos
Part II
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?
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 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…
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
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 objectives?
Reduce pain
Prevent recurrence
Remediate/ remove the cause
Footwear
Exostosis
Interdigital Silicone Wedge
Cushions the exostosis
Keeps the involved toes apart
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.
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…
Changing footwear
Lower heel
Strap across toe box or wider toe box
Possible surgery
Excise exostosis
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 objectives?
Reduce pressure
Alter footwear
Redistribute forces/ cushioning
Offer comfort
Maintain tissue viability
Ensure education/ inspection
Hallux Valgus Crescent in Rolofoam
On examination:
Fixed toe deformity
Apical lesions on the middle
three digits of B/F
What are our objectives?
Enhance comfort
Reduce recurrence of the apical HK
(As deformity is fixed unable to alter
structure)
Toe prop
Provides cushioning to apices of digits.
Reduces weightbearing contact and pressure
over the apices of the digits.
Along with…
Scalpel debridement of HK