Silicon Prop for pt with RA?

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I have a pt (aka mother in law) with RA. She has a very painful HD on the apex of 2nd toe. I want to put in a silicon prop under the toe to relieve the pressure, but as she has RA, I am wary..
Can anyone advise on this?

Thanks.

 

My advice... don't treat your mother in law...

 

Hi Lucy, I´m not really sure what the problem is.


You have a HD which you want to off load to give her some relief from pain, go for it and if she finds it painful remove it.

 

If she has a non reducible hammertoe contracture that forces the tip of the toe into the ground and this is causing the callus then yes a silicon prop can reduce pressure on the tip of the toe. I've used the silicon mix to form what we called in podiatry college a crest pad. The goal of the crest pad is to change the weight bearing location on the toe from the tip to the entire length of the toe. Often you will want to support more than one toe. You can mix the silicon and form a flat slab and incorporate some tube gauze in the center of the silicon by folding it over the gauze. The gauze will help hold the crest pad in place. Make it too thick and then it can be easily trimmed with a scalpel. If it is the first time you attempted this, it may take you a couple of tries. Wrap the tube gauze over the tops of the toes before place the slab in the sulcus of the toes.

I would worry much more about a foot with absence of sensation or very poor blood flow than I would about a patient with RA.

Good Luck,

Eric

 

I was so intrigued with Eric's suggestion that I went to try it. We use Otoform Kc vulcanised silicone putty here for such props and I have never seen gauze or tubegauze incorporated into it. I'm finding that it does work but not sure about how long it would last in situ.
I would usually incorporate a flange on each side of the prop, coming up onto the dorsum, and often incorporate 234 toes so your flange comes between I&2 and 4&5 toes. This keeps it in place pretty well.

Don't blame you for wanting to move over to Melbourne Lucy, it's a great city, but the weather is much the same as here in Scotland at the moment - wet and cold!

 

yeah, my dad lives in pt melb and keeps telling me!! Can't wait.. one yr and counting..

 

For pts who cannot tolerate the "hardness" of silicone props I will use tube-foam made into a roll-foam prop. Some prefer the feel and results of this.
If the toe does not move at all and this softer prop is not possible then my final attempt will be for the pt to wear deep shoes with extra filler/soles. I then cut apertures to allow the toe to "drop down" thus reducung friction or pressure. However the pt needs to be willing to wear said shoes (ALWAYS a problem when I worked in the UK). Finally I would agree with Ian, do not treat mother-in-law and leave the country.

Fraoch

 

If you are not experienced with the handling of silicone, can form a device with cotton fabric tube which is introduced into a ball of cotton wool.
Rubbing with the fingers form a sausage that is placed on digital sub-space of the middle fingers, passing the ends of the tube of cotton between the interdigital spaces, is the first and fourth, to the back.
On the back of the fingers we made a smooth knot (not pressed) and the ends are re-introduced by the interdigital spaces, is.
It is hygienic, because you can wash the cotton tube and replace the interior cotton bath or shower in each of the patient.
It's affordable, and the patient can adjust the amount of cotton used at your convenience.
I hope you can understand the difficulty of the language.
Greetings Teatino

 

Hi Lucy,

I was always told to let my otoform devices harded off for 24 hrs beofre the pt wears them to make them last longer.
Whilst this is true I've found that they are tolerated much better if they wear the device straight away, as the polymerisation process hasn't been completed this allows for some dynamic moulding and the device lands up alot softer. If it is uncomfortable in the shoe you can make an immediate adjustment.
A few drops of baby oil can be mixed in with otoform to make it softer, there are softer silicones available but they have a longer mixing time before they can be moulded and are very messy to use if you get it wrong.

Good luck

Nina

 

There is a book, published in 1992, called "Podiatric Office Management And Procedures" which demonstrates the crest pad manufacturing technique.
The book is a generally excellent text covering most all aspects of podiatry practice. Chock full of information for the podiatrist at any skill level.

I see the are a few of these books available on Amazon for about $75 US
Well worth the money.
Tony Jagger

 

I sometimes use for pt with reduction of FF fatty padding 5mm semi compressed felt with tubeguaze similar to Eric's way with ottoform, cut lenght of SCF, with length of tubegauze detimined by wrapping the necessary digits, then stick tubeqauze to SCF and fold SCF over giving a removable soft prop. So may different ways of doing things out there. I agree leave england, I want to live in NZ.

Nick

 

netizens

Moons ago when I developed the technique of serial silicone putty props it was on populations with Rheumatoid diesease. The intension was to devise a prophylaxis against lateral drift. Using the STJN position as a reference we undertook a linear study at Hasting District Hospital on a group of RA patients. There were several opportunites over a period of seven years to review patient progress. In all cases significant change in toe position was recorded in the surviving subject group and 'predicted' lateral drift had not taken place. The study stopped after the rheumatologist retired but throughout my association with the project (1979- 1986) surgical colleagues did make comment to the RA Department why the number of RA patients requesting digital surgey had dropped.

toeslayer
Footnote
I am always interested to note when new materials are made available podiatrists insist in incorporating older techniques rather than use the materials and their properties to surpass that which went before.