Padding and strapping

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Hi all

I have been teaching Padding and strapping to first year students for a million years here in South Africa.

I am currently looking for new ideas for the teaching of what seems to be a very boring subject.

Please share with me any ideas you may have on the subject or any good stories you may have from your training in Padding and strapping.

 

I sympathise. Back in the dark ages at Brighton Uni I can remember Thursday afrernoons as a time to roll my eyes and rest my brain. P&S is just not interesting until you are a few years out of school and find all sorts of ways to do fantastic things where other modalities and therapists have failed.

I am currently boring Canadian students (who have no interest in anything if it's not on Facebook) about P&S. The ones who really care and have an ability to use their brain practically do fairly well. Jesus I sound like my mother, I must be getting old.

Sorry I have no hints or words of advice. Anything that i have come up with would not pass an ethics committee; e.g. placing a drawing pin through a shoe and getting the students to pad their feet around it effectively. I'm only kidding OK? Well, sort of.

I make them stand and walk to test the effectiveness and get the kids to rate each other but you can just sense the boredom. Then I think I lose my voice saying "if the first 5 otoforms didn't work don't you think there should be a planB with felt and tape?"

 

Dennis why not make them intersted in the Biomechanical changes in the foot after strapping or padding.

ie Maybe get a force plate- get the students to strap the foot using various anti-pronation tape methods and see the difference on the force plate no tape with tape- same would work with padding. It maybe boring but if students can see a practicial purpose it might make it more intersting.

 

Have you tried taking them to an athletics track and trying the P&S on athletes or themselves to get a full picture of what they do and how they feel???

 

netizens

Been there and done all that. Re gait analysis with force and pressure is there no sugnificant difference with pad or without. Or it the results can be fraught with complication. This sometimes raises more questions than engages interest.

Most of the guff which is still associated with tradional padding in text books is utter nonsense eg deflecting pressures. If the foot is a kinetic model moving forwards the idea of deflecting force per unit area backwards is silly. So a project redefining the nomencalture is a worthwhile for eager students and especially so when linked to absence of gait analysis. A project such as 'something works but we are not sure why,' can be worhtwhile and bring a few surprises.

Taping does have a lot more written about it in both physio and physical therapy literature which makes it all together more fruitful from a publication research perspective. The student do need to look beyond the linited podiatry text however.

My approach was to use material science to give students a definable indication that might assist in clinical problem solving eg modulus of elasticity etc. This was as a prelude to classifying orthotic materials by material science and so there was a deliberate intellectual link. I also used a workshop approach to master the basics of cutting and bevelling etc then with worksheets (on -line) the students would endevour to complete a portfolio of work (equal to the range of common prescriptions). By the end of the semester, students could then present worked examples of padding in clinical use. These was an OSCE to test intellectual aspects of padding and taping.

All the material was on line. The carrot was always in the assessment - make it mandatory and the students comply (They may not like it).

toeslayer

 

It is a million and one years. still use what you tought me Den, it still has value for comfort and protection, but not really mechanically . Gotta be done though..

 

dennis i strongly agree with you, we need to move with the times, padding and strapping needs to be scrapped as a subject/practical in podiatric medicine circles, as it saves no purpose other than cushioning and comfort with no mechanical corrective input........i can see hapla plc getting mad with me. biomechanics has moved with the tymes, so i hope we at home can move with it too, i like the radical thinking of kirby, spooner, hicks, dannanberg et al. i strongly feel that the way forward for our proffession's sake.

 

So someone with a Hard Corn that you have removed gets no benefit from a plantar cover with a cut out where the enuculated corn was ?

And apply a medial wedge made of felt added to and insole ie a type of skive has no place in Podiatric practice?

Strapping to reduce the loads however short time has no role in a person with an lateral ankle sprain?

or a reverse mortons extension has no effect on reducing the 1st MTP dorsiflexion stiffness?

Mr Nake felt and strapping has a huge role in Podiatric medicine and benefits patients daily. And you can see that the SALRE or Sagittial plane theory can be used in here as well.

While I agree biomechanical treatment must move with the time Felt and strapping has it´s place. Remember that if we are trying to help a patient by changing or reducing loads on a tissue there are many ways to skin a cat. Some available to directly- Felt and sports tape, some longer such as orthotics.

 

For the record: I use felt and strapping on a daily basis.

 

"Padding and strapping has no mechanical corrective input"?? Absolute nonsense!!!

 

How about you have a full body wax; and come into class the first day, and substitute Adam and Eve's fig leaves for the leuko premium?

I reckon you would sort the bordom out with one "short" appearance.



Learning to strap (moreso than pad IMO) could be the most effective, dramatic, symptom and sign changing technique that a physio/pod has in his knapsack. Furthermore, the outcome may influence treatment options. Toeslayer's advice about looking outside the profession has some merit IMO.


Not hard to find a few volunteers with first-step pain in the morning. Get them in...group environment and get them taping and re-assessing.



Ron Bateman
Physiotherapist (Masters) & Podiatrist

 

Thanks for the comments guys and girls.

I am NOT trying to do away with the old fashioned padding and strapping. I am trying to modernize it a bit.

It may not be useful from a biomechanical sense, but is still very usefull in clinical practice

 

Dennis

Making students aware of padding and strapping techniques can be used as a useful curriculum event either as an end on event , or prepration for other aspects of podiatric study. I juxtiposed 'padding' with classic anatomy and kinesiology. Syllabus wise this fitted in well and gave a useful practical opportunity to develop manual dexterity, spacial conceptions and problem solving.

Like so much of what podiatrists do, this poses more questions then answers but that by itself is a useful motivation to enquiring minds. Managed well 'padding and strapping' core teaching is a safe means to assist students to develop their analytical approach.

toeslayer

 

I still use P&S on a daily basis and encourage younger colleagues to do so.

Dennis perhaps trying teaching P&S on real patients-will require more work and planning but may be worth considering-in that way students may grasp teh concept better.

Good luck

 

Howzit! Dennis!

I also still use P+S daily and while biomechanical concepts are relevant i find there's often a gap between our wishes as practioners and the patients view of what they want - esp. in the aged, who are often sceptical/suspicous of practitioners wanting to change their footwear ( ie "image") and increased costs of orthotic therapies. Besides, i think judging soley from a longer term biomechanical perspective, neglects that padding still has some justification in being tought for treating the mobile patient with minor wounds or pressure induced lesions, until you can assess/ persuade patients of their best long term needs. The increased use/concepts of biomechanical treatment do, justifiably raise questions of our traditional thoughts of p+s use, but its difficult to apply generally when the older quick, easy , and relativly cost effective treatments are requested by a significant number of patients in general podiatry practices. I can think of several of my patients who have sourced biomechanical devices from varies practices but still prefer the feel and convenience of old, traditonal padding. I acknowledge their wishes while still offering the newer concept / materials if they change their mind later.

Dennis, on trainig; i still like the concept we used to use, of initial practice in padding ( and correct, safe scissor use!) on fellow students and then assigning these "newbies" to the 3rd and 4th year students for the specific purpose of doing any clinical dressings required. The effect was two fold - junior students practice padding with incentive to perform and pester the seniors for answers about the patients they are assisting with; and the seniors are required to think constantly even with mundane treatment and it enforces padding concepts. i dont know if this still applies at Jo'Burg Uni, but seemed a good concept years ago.

The thought of you being fully shaven before class should raise class interest and have the added benefit of reducing drag and improving your ulta distance performances.

Otherwise keep well Den.

Barrie

 

Hi All

I too use P&S on a daily basis and Hapla's bottom line would suffer severely if I stopped.

I do a lot of rural and remote work where I need to give the patient something now as I may not see them for another 4 weeks. I'm well aware that strapping won't last four weeks but teaching a patient how to strap can. Or using felt to make some "temporary" biomechanical adjustments to existing footwear and/or orthotics to judge a patient's acceptance is much cheaper than taking their orthotics for two weeks while I fix and post back and then having to do it again because it wasn't quite right. It's also has better patient compliance than telling them to wait four weeks until we have all the right shoes or devices!

Many (not all) patients do like being able to "trial" something for a few days or weeks to judge outcomes before spending money.

I have no idea but maybe students would see P&S as more interesting if you could convince them that an orthotic alternative is sometimes something you simply don't have and the problem needs to be fixed NOW. Lets face it - sports physios work wonders with only strapping in 2 minutes on a Tennis court.

Maybe we should dump bored students in a desert community for 2 days with only strapping and padding supplies - they can only come home if they make a certain number of patients happy with the treatment they receive.

Good luck to those who teach this topic
RStone

 

netizens

The padding and strapping models I used in undergraduate programs involved practice workshops run in the pre clinical modules then the students would work on real patients to consolidate their practice (after they had shown basic competences). Part of consolidated practice involved reflectve/review progress. I think most courses do the same.

I do agree with RStone's comments however in regard to the use of padding as an alternative to foot orthoses. Pods have afterall been successfully dealing with symtomatology for decades before plastic orthoses were available. I do think published clinical guildelines such as the Australian Guidelines for Orthoses (published by the APC) have not helped in this matter. The strong inference is all padding is temporary and should be converted to foot orthoses as a natural progression in professional care. Now whether this was meant by the authors or has come to be accepted by employers is not at all clear, However many contracts of employment now involve moving padding care to foot orthotic care as standard practice.

I certainly do not agree with this and feel one of the disadvantages of mono-discipline clincial guidelines is they tend to be too discipline-centric and something that is often maniputed for profit.

What say you?
toeslayer

 

Toeslayer

I do agree that too often it is manipulated for profit. I personally cringe when a patient comes and says "and just because I've come here doesn't mean I want an orthotic for the rest of my life". I don't like to think that in progressing technologically we've been "seen" to have narrowed our treatment options to orthotics alone.

Orthotics certainly have their place and I use them daily BUT if I give a patient some felt padding in a shoe for 4 weeks and they contact me later and say the problem is fixed and they've never felt better thankyou I don't push them to swap to an orthotic. If they are happy to come in once every 12 months with a new pair of shoes for a new piece of padding that's fine with me.

Whilst we do need evidence based treatments the fact still remains that somethings are harder to measure and maybe harder to write into policy documents - it doesn't make them useless or obselete.

Just my 2 cents worth
RStone