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Protection of a fifth toe with ulcer and diabetes

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  #1  
Old 6th October 2006, 02:14 PM
fred fred is offline
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Default Protection of a fifth toe with ulcer and diabetes

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hello,

I used an orthose as EVA moulded hot
very flexible material and soft

know this technique?
that made you in this case?

thank's for all
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Old 6th October 2006, 05:05 PM
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Cameron Cameron is offline
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Hi Fred

If it works then you can ask for no more.

A general problem with tubular devices, especially solid ones, is they rotate longitudinally on the toe. The advantage of the second skin means external friction from foot movement etc. occurs on the outside of the sheath , but sometimes the interface between the sheath's inside and the lesion can also be prone to dynamic friction which interferes with healing. Also sometimes where the traditional pad maker may come across problems is when prescriptions leave edges e.g. crescent. which catch the surface of the lesion or further irritate this with rough edges from adhesives etc. One further problem with the device you have demonstrated is with use it will plastically deform and any advantage the sheath has is lost when it integrity changes.

I like the silicone tubular bandages where there is no risk of toe constriction these provide simple covers with the advantage of a siliconised surface to offer pressure resistance and more especially reduce shear levels across the lesion's surface. These can be washed and therefore arguably more hygienic than a sheath potentially contaminated with exudates.

There are other ways to approach this problem and when I get access to a decent photo file I will post it. The secret is to breakdown the reaction forces across the skin surface, then look at where reultant forces cross to give a crokscrew effect on the lesion. The most effective way to deal with the problem is a subtle dorso-medial crescent lying off the lesion. Can be formed from a silicone putty toe spacer.

Cheers
Cameron
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Old 7th October 2006, 01:47 AM
javier javier is offline
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Quote:
Originally Posted by Cameron
There are other ways to approach this problem and when I get access to a decent photo file I will post it. The secret is to breakdown the reaction forces across the skin surface, then look at where reultant forces cross to give a crokscrew effect on the lesion. The most effective way to deal with the problem is a subtle dorso-medial crescent lying off the lesion. Can be formed from a silicone putty toe spacer.
This is the most successful approach, at least for me. I have been looking for a photo on my archive, but I have not found none showing this design. If I have the chance, I will upload one.
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