Osce Flashcards
What fibres does a hallux proprioception test
A-alpha fibres
Know where the foot is in space
Cramps
Involuntary, painful, self limiting contractions of skeletal muscle
Fasciculation
Random, painless muscle contracture
Twitch
Muscle atrophy
Muscle bulk is smaller than expected for body size
Muscle hyper trophy
Muscle bulk is larger than expected for body size
Muscle psuedohypertrophy
Muscle bulk appears larger than expected for body size-however this is due to overgrowth of fibrous or fatty tissue
Allodina
Pain evoked by a stimulus that does not normally evoke pain
Hyperalgesia
Increased pain response to a stimulus that is normally painful
(Suggested to be a consequence of peripheral and/or central sensitisation)
Dysthesia
A spontaneous or evoked unpleasant abnormal sensation
Eg; finding pins and needles unpleasant
Paraesthesia
A spontaneous or evoked, abnormal but not unpleasant sensation
(Eg; if someone finds pins and needles abnormal but not unpleasant)
Hyperesthesia
Increased sensitivity to stimulation, including diminished threshold & increased response
Grading reflexes
Absent/present/exaggerated
Note symmetry
Neurological assessment risk factors
Diabetes mellitus, alcoholic neuropathy, nerve entrapments, loss of sensation, spina bifida, cerebal palsy, muscular dystrophy, sudden falls, post surgery (eg; mortons neuroma)
Homocysteine
Amino acid - alterations in it’s metabolism are a recognised independent risk factor for PAD
Hypohidrotic skin is indicative of PAD
Clinically presents
As the metabolic need of the skin are not being met.
Clinically presents as dry flaking skin of the dorsum/plantar & extending up the leg
Intermittent clarification
Transient ischaemic muscle pain that occurs during exercise - strong indication of significant PAD
Rest pain
Typically occurs when legs are elevated.
Persistent pain that is caused by nerve ischaemia -> ischaemic neuropathy
Orthotic therapy
The use of an appliance or apparatus to support, align, prevent it correct deformity or to modify position or motion and improve the function of the moveable parts of the body
Orthosis
Orthotic device
Plural- orthoses
Anatomy of a non-cast insole
Consists of base- generally just a vehicle, can provide some cushioning
And
Padding- this will determine the function of the device (cushioning, padding, deflection, alter plantar pressures)
Shell material
Polypropylene
-3mm or 4mm
Polypropylene
Yields pressure and torque
Economical
Oven temp 180-200degrees C - 3min per mm
Copolymer polypropylene (contains up to 15% polypropylene)
Carbon composites shell material
Carbon composites make light rigid shell materials from carbon fibre composite & polypropylene
Ethyl vinyl acetate
Grinds easily
Retains shape well
Reflect body heat
Lasts 1yr
Shore value
= hardness (not density)
Low density EVA (220)
Shock absorption
Shoe uppers in temporary shoes
Stabilisers in AFO
Shore value of 25/35
Medium density EVA 270
Heel lifts Shoe blessings Moulded insoles So-rigid stabiliser Shore value 35-50
High density EVA 350+
Shoe lifts Heel lift Block heels Wedge bottom Rigid insole
EVA is mouldable at what temperature?
120-170* C depending on density with an oven time of 2minutes per mm
PPT
Lining material
Open cell polyurethane memory foam
PPT
PORON
4000
92 ultra soft
94 slow memory
Dual layer
Plastazote
Lining material
Coverings
Vinyl
Cambrelle
Types of padding
Corrective padding
Compensatory padding
Palliative padding
Corrective padding
Used to realign musculoskeletal components of the foot and restore function
Compensatory padding
When correcting is not possible (when correction is not possible) padding compensates for the loss of function
Palliative padding
Used to cushion or redistribute load away from a specific area
Padding principles
Use stretch of materials
Bevels
Allow function
Strapping
Rounded ends
Never end in a double thickness
Should not interfere with normal foot function (except splint)
Should not overlap tendons or interfere with function
Avoid peri-ungual tissue
Avoid nail plate
Half the strap on the pad and half on the skin
Felt
2, 3, 5, 7, 10mm
Matted wool
Material of choice for corrective padding- most durable
Fleecy foam
Soft foam with strength of fleece.
Cushion & protect areas from stress and pressure.
Highly compressible, instant recovery, ideal for light cushioning
Foams
Molefoam - latex foam bonded with a brushes surface
Absorbs pressure
Instantaneous recovery
Ideal for cushioning & plantar pressure redistribution
Fleecy web
100% cotton padding with a raised fleecy surface.
Transverse stretch allows the padding to conform to the skin which prevents creasing
Conforms well to difficult areas (bony prominences)
Bevelling appropriate angle
45*
Before you apply a pad you should
Check for allergy
Use a barrier wipe
Precut your pad and strapping tapes before applying to the patient
Types of digital pads
Digital covers Digital props Digital crescent Horseshoe pad Interdigital cover or wedge
Basic pad shapes
Crescent pad- used on digits to protect IPJs
Digital cover or oval pad- usually used in conjunctions with a cavity or aperture- used to hold medicaments or protect bony prominence
Replaceable toe prop
Can be used to straighten toes of reduce the pressure on the apices of toes
Horseshoe pad
I-shaped pad used to deflect pressure away from either IPJs
Plantar pads
PMP Plantar cover Shaped metatarsal bar Straight metatarsal bar Valgus pad
Plantar cover
Anterior border- follows the webbing of 1-5
Posterior border- thumbs width distal from the styliod
Follow the medial and lateral lines of the foot
Wing
Material is removed from the pad leaving a back-beveled crescent shape cut-out to accommodate a lesion, usually either under the 1st or 5th or both MPJs