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Winged Pad on the 1st MTPJ

Discussion in 'General Issues and Discussion Forum' started by cperrin, Jun 9, 2008.

  1. cperrin

    cperrin Active Member


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    Dear all

    Just a quick question.

    I am a 2nd year student and recently started looking over all my padding notes from year one. In looking at them we were told that to offload pressure on the 1st MTPJ then a winged pad over that area of semi compressed felt would be the pad of choice.

    However wouldnt this be basically using a kinetic wedge effect forcing the MTPJ down enhancing hallux dorsiflexion.

    If you where using something like 5mm scf the MTPJ woud surely still have quite a large contact with the ground and therefore would not offload that much pressure atall. If this is the case could this be corrected with the use of a moalfoam button or in the case of an ulcer something like biatin

    Just a thought and im prob completely off the mark, and whether i would actually use a pad or not this will bug me days

    Thanks for any help

    Chris
     
  2. Cameron

    Cameron Well-Known Member

    cperrin

    Many of the claims for traditonal chiropodial padding are well meant but inaccurate. More charming the properties attributed to them are rarely challenged and have become rather 'sacred cows' as a result. When these spurious traditonal properties are superimposed onto the practice of podiatric biomehancs (itself imprecise) then more no science or nonsense results. As a student it is probably best to attribute these claims to a reliable source and whilst you may not agree, you are at least qualifying where the information came from.

    It is not that difficult to test the properties of padding and this would in any undergraduate degree make for a decent research project. Only then when you have a set of results would it be appropriate to challange the claims by arguing from an informed perspective.

    Well worth the effort I think.

    toeslayer
     
  3. pgcarter

    pgcarter Well-Known Member

    Creating something to offload the 1st met head is not that easy, after all the 1st met head is supposed to do a fair bit of work, and in most people it does. A bit of felt is not going to do it very well. The current understanding of 1st ray mechanics is such that anything that facilitates 1st ray plantarflexion should increase 1st met head loading. In order to offload it well I think you need to be far more definite with your materials in loading up all the other possible structures around the 1st met head, and this needs to be set up for both foot flat and heel off phases in order for it to be very effective. I think you need to prevent 1st ray plantarflexion to some extent by trying to load up the 1st met shaft and all the other met heads and particularly distal to the met heads for late stance push off, to try and stop the foot rocking onto the 1st met head after heel lift. Always a challenge to have enough room in shoes to make it effective and always a challenge to explain to my students in the past that yes a 1st ray cutout is supposed to help load up the 1st mpj but that yes it does look awfully similar to a 1st mpj cutout/offload.

    If they look that similar they probably have fairly similar effects......so make sure they don't really look all that similar and they might do something different to each other.....

    just my two cents worth..
    regards Phill
     
  4. Can someone explain to me what a "winged pad" is? This is not terminology I am familiar with. Does a "winged pad" fly?? We already know that pigs fly, since they have wings. :pigs:An illustration would be nice.
     
  5. cperrin

    cperrin Active Member

    A very rough drawing i just did on paint. The imaginary lesion would be on the 1st mtpj.
     

    Attached Files:

  6. Hello,Just to say that in twenty years of practice I have yet to dispense a winged pad...
     
  7. Adrian Misseri

    Adrian Misseri Active Member

    G'day Chris,

    I do a bit of pading in my practice, using all sorts of materials and sizes and shaped to offload all sorts of lumps and bumps under the foot. My best advise is make use of the learing environment whilst you can, go into your grinding room, grind up a whole lot of little pads (like a winged plantar cover and a kinetic wedge and met dome etc) and put them in your shoes, and see what they actually do to your foot. It's amazing to see how much or little padding you need sometimes to create a desired effect.
    My understanding of a winged 1st plantar cover is like Phil suggested. Has to extend past the 2nd-5th MTPJs, but also support the 1st met shaft. I usually make mine so that they load the shaft just proximal to the head of teh 1st metatarsal. Just remember that even though the 1st metatarsal head still will contact the ground, doesn't mean it's still taking the same forces. The goal of padding quite often is to reduce and redistribute pressure, not necessarily remove it all together. Try the padding using a 3mm piece of 150 EVA and see how it feels
    Cheers!!
     
  8. betafeet

    betafeet Active Member

    Good stuff back to basics, giving the patients instant relief. I often use these various felt paddings before going ahead with orthotics.

    jude
     
  9. heleneaustin

    heleneaustin Active Member

    I quite often start at the basic training i was given and start with 10mm winged pmp with cut out to 1st mpj similar to cperrin's drawing. They quite often relieve the symptoms but i'm not a lover of them long term for hygeine reasons. Long term i would prescribe a simple insole of regen base or poron base with a poron padding of 6mm or more covered with suedette or synthetic leather. If this didnt work then a more long standing orthoses would be choice.
     
  10. markjohconley

    markjohconley Well-Known Member

    Helene, do you find the poron satisfactory in deflecting sufficient pressure off the lesion?
     
  11. markjohconley

    markjohconley Well-Known Member

    Phill,
    Nice intro.

    I've always felt that felt (on the dorsal surface of the sock lining / orthoses) is an excellent 'trial' material, it must move plantar forces (maybe not where you want them to go)

    Can that be read as "across the forefoot"?


    Why? Why not "you need to decrease plantar pressure on the 1st MPJ"? Isn't this able to be done without preventing 1st ray plantarflexion?

    Thanks, Mark Cl
     
  12. Adrian Misseri

    Adrian Misseri Active Member

    I've found that the thicker poron works really well, 6mm is good. 9mm can be a bit thick though. Alternatively, some 5mm 90 density EVA is useful too
     
  13. Scorpio622

    Scorpio622 Active Member

    Mark,

    I've always felt that you felt that felt is an excellent trial material. I've felt the same about felt until one day a patient felt the felt too much and felt that it was making her worse. Since then I've never felt the same about felt.

    Gone insane :wacko:

    Nick
     
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