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A common pressure deflective device for overnight use is the donut pad. For these pads I use 10mm felt as does it seems a majority of other pods. Wouldn't it be 'safer' to instead of encircling the lesion to apply only a distal device, a reverse crescent pad. The concern is that by applying proximal pressure perhaps circulation to the lesion is inhibited??? Any anatomy wiz's please.

 

Hello there

First off, I'm not calling myself an 'anatomy whizz' (or any other kinda 'whizz' for that matter)!

I'm not altogether sure I understand your question - are you thinking that the pressure exerted proximal to the malleolus (by the pad) may be sufficient to compress the arteries supplying the area? If so, that would depend on the local arterial pressures, as well as their anatomical position - specifically how superficial the vessels are. Personally, I suspect that other issues (i.e. degree of PVD, underlying medical conditions, etc) are likely to be more influential in these chronic lesions.

Although, I have to admit that I have come across lesions that are poking out of an aperture in a ring pad & wondered whether maybe some other type of device might be more helpful. Which leads mt to the question: are you actually wondering about compression of superficial vessels by the padding?

Do your patients use devices to reduce pressure over the whole foot & lower limb? In a former job, we found the 'repose' boot to be tolerated well, low-cost & helpful.

 

hi sarah

yes

Any reference, I may know it under a different name, and thanks for your reply, mark c

 

Try www.reposedirect.com for more info. It's an inflatable device. It is designed to prevent heel ulcers (i.e. in the typical posterior location), but is deep enough to accommodate the malleoli.

The other option is to consider whether the patient could sleep in a different position (not always possible, I know), or whether a matress or overlay is appropriate.

Sarah

 

thanks again, Sarah, will have a peek, seems we don't have any anatomy wiz's prepared to give it a go, all the best, mark c