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5mm felt vs 10mm felt

Discussion in 'Diabetic Foot & Wound Management' started by davidjohnconley, Oct 3, 2005.


  1. Members do not see these Ads. Sign Up.
    as for modifying orthoses / insoles/ socklinings temporarily to deflect pressure from neurotrophic ulcers whats the opinion of my learned peers. i personally prefer the 5mm-ish felt in preference. i like the softly softly approach as it seems to be as efficacious in offloading pressure and less troublesome with inducing "leg length discrepancies", and edge effect. What say you?
     
  2. Cameron

    Cameron Well-Known Member

    One problem that exists when modifying a foot orthosis which is stained with exudates is to prolong contact with a contaminated surface and wound. I prefer to use serial plastazote inlays which are replaced at each visit. These are cheap and dynamic shaping of the expanded polyethylene ensures a mirror image of the wound. Reduces peak pressure. The material insulates the skin and maintains temperature preventing cold spots. If you are going to use the original inlay I would place a thin layer (3mm) of evazote over the original insole. You can use twin backed sticky plastic as the adhesive. The addition can be done safely at the chairside. Plastazote and evazote share the same physical properties.

    One fault many people make with the original insole prescriptions and subsequent additions is the actual 'U' or wing sits too far back from the lesion to perform optimally. Patients cannot tell a good fitting pad prescription from a bad one. They merely can sense comfort or otherwise from the shoe insertion. One simple way for the practitioner to tell if the wing or U sits in the right position is to see from the wear marks if the indentation caused by the metatarsal head matches the pad prescription. There should be no posterior gap and often there is. Why most prescriptions are misplaced is due to practitioners ignorance of heel pitch. When prescription are made to flat templates when in the shoe and the insole shapes to accommodate hell pitch it set the prescription back approx 1 mm from the lesion.

    Back to your question, thickness is determined by available dead space in the shoe. The thicker you can get away with the better but when dealing with insensitive feet best to err on the thinner addition. I would advise you put this on the under surface of the inlay and not over the original prescription. The reason being – best to keep the interface between foot and inlay without interruption.


    Cameron
    Hey, what do I know?
     
  3. thanks cameron, haven't used plastazote for 15 years, do remember observing some excellent results (resolution of heel ulcer was one) with moulded plastazote (a la pod Majella Smith). i certainly will give it a go and allow "dynamic shaping" to mould the inlay. to get "accurate" positioning of additions i usually let the pt wear the insole (Formthotic) for ~2 weeks and then adhere 5mm felt deflective padding (if it gets soiled no worries replacing it) i ain't no gun podiatrist but i'm constantly amazed at pods fabricating inlays/ orthoses off unshod feet>>> not much chance of accurate positioning as the foot (and its components) unshod is not the same as in the shoe, ain't it? also i have trouble with 10mm felt pads with apertures adhered to soles of feet>> maceration, wearing plastic bags in showers, functional lld's as for top or bottom i have always used additions on the top surface , it might increase the edge effect but i feel it is more "accurate" would you extrapolate on why you use them on the bottom surface, thanks again
     
  4. Felicity Prentice

    Felicity Prentice Active Member

    Hey - do you know where Majella is now? She was one of my very favourite students, and I would love to know how she had got on in this wacky old world of Podiatry!

    cheers,

    Felicity
     
  5. Cameron

    Cameron Well-Known Member

    David

    >...would you extrapolate on why you use them on the bottom surface, thanks again

    The interface between the wound surface and the upper section of the inlay has dynamically formed through wear, the addition of a new piece of material may increase the coefficient of friction causing added drag with dynamic friction. When epithelialisation is at a critical stage , this can be detrimental. The additon on the under surface does not directly interfere.

    Cameron
     
  6. Michele

    Michele Welcome New Poster

    Hi, I tend to use felt on underside of insole for reasons already mentioned and also hygiene, insole is easier to clean. does it have to be 5 or 100? Felt can easily be stripped back to thinner layers to make say 8mm and add as required or as compresses.

    regards Michele
     
  7. as an example, i just now reviewed a pt with R.A., p/s 2nd mtp jt ~2x1mm shallow ulcer (1st seen by pod 4/52 ago), has prescription footwear and orthoses (p-lite moulded) from the orthotic/prosthetic dept, pod had used a 10mm felt deflective adhered to skin, i fiirst reviewed last week noting it had improved to be ~.5x.5 mm shallow with said Rx, however i changed to a 5mm felt adhered to top cover of orthoses and today i note it has continued to improve to not needing callus debridement. note the primary pod has arranged a consult for the pt with the o/p dept for reassess, especially moulded orthoses. so for short-term Rx deflection of pressure why not 5mm felt on top? and michele, i am notoriuosly slow, so i prefer the stock 5 or 10 mm as reducing to a desired lever takes time and there ain't enough of that
     
  8. cameron (and michele)

    cameron
    again thanks for the feedback/opinion, question if a lesion has developed then wouldn't this indicate that the inlay is not the appropriate contour?, thanks, mark c, yep i'm working (only fool to put my hand up)
     
  9. Cameron

    Cameron Well-Known Member

    david

    >again thanks for the feedback/opinion, question if a lesion has developed then wouldn't this indicate that the inlay is not the appropriate contour?, thanks, mark c, yep i'm working (only fool to put my hand up)

    The lesion (metabolic rate of reproduction of kertin cells) is controlled by biochemistry and physical protection offer by cushioning by absorption or ''deflection'' (never like that term) after the initial damaged to the keratin envelope would have little real effect on metabolism. So the lesion would continue to manifest, despite the padding. Regular reduction would help reduce bulk and combined with physical reduction on heat and pressure might temporarily give the impression of an improving lesion. In chronic cases whiist improvements are common place the lesions will return in absence of treatment.

    So to answer you, yes the inlay needs to matcgh as much as it can the lesion and provide appropriate protection (whatever the means )

    Off to the beach with the grand kids I love Christmas in the sun

    Have a good one
     
  10. Foot fan

    Foot fan Active Member

    In amongst all of this, do not forget this device has to go back inside a shoe. I prefer to use 5mm felt given it tends to fit in shoes more readily than the 10mm counterpart, depending of course on the depth available in the shoe and the arch heights of the patient. We also use a lot of plastazote - tends to flatten quickly and gives us a rough estimate of where the problematic trouble spots are (besides the ulcerated ones).
     
    Last edited: May 18, 2006
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