Unit 4 - Foot Health Team Management of Foot Deformity Flashcards
Socks
Function of socks (4)
reduce friction between the skin of the foot and footwear
provide some cushioning and protection to skin
absorb and wick moisture away from the skin
help contain heat in winter
Socks
Types of sock fibres
How do the fibres differ?
natural fibres: wool, cotton, silk, hemp or bamboo
synthetic fibres: acrylic, nylon, polypropylene, spandex
each fibre has different properties of elasticity, absorbency and loss or retention of heat
Socks
Which type is best?
there is no strong evidence that one fibre or type of sock is truly superior to another
Advice to clients about socks:
Fit (4)
socks need to fit
too big, they will bunch up in the shoe and add pressure
too small and they can cause pressure on toes and toenails
too tight and they will constrict vascular and lymphatic flow
avoid tight “cuffs” at the top
Advice to clients about socks:
Condition (2)
darning or mending socks will create unwanted pressure points
discard socks with holes
Advice to clients about socks:
Hygiene (3)
wear clean dry socks everyday
change socks during the day if feet are very sweaty
wear socks with less than 25% nylon content to decrease sweating
Advice to clients about socks:
Seams (2)
bulky seams can create points of pressure on fragile skin
some people wear their socks “inside out” to minimize pressure of seams
Shoes MUST be…
Shoes MUST
FUNCTIONAL
FIT
What do FUNCTIONAL shoes do? (4)
protect feet from injury
provide a stable platform for walking
work with or to enhance our natural gait
can provide shock absorption and cushioning with heavy activity (like running) or when on hard surfaces (like concrete)
Advice for shoe fitting:
What type of shoe is suitable for most people? What type of closure and why? Upper Sole (3) Arch Heels
good athletic or walking shoes are suitable for most people
velcro or lace-up closure because it holds the shoe firmly onto your foot and allows adjustment for periodically swollen feet
soft breathable upper that provides protection from minor injury
sole
non-slip
provides some cushioning or shock absorption
flexible under the metatarsal heads
comfortable arch support
no heels > 1” because a higher heel shifts too much pressure to the front of the foot
Advice for shoe fitting:
Shoes must fit in all three directions…tell me more.
Length
long enough and has a finger’s width (1/2” to ¾” or 1-2 cm.) space between end of the longest toe and the end of the insole.
Width
toe box wide enough to allow toes to spread out naturally without rubbing on the sides
Depth
toe box deep enough to not rub on the tops of the toes especially if toe deformities are present
Advice for shoe fitting:
While looking at shoes in the store (4)
remove insole and stand on it to check size
check inside for rough edges or inseams that could rub on skin
shoes should feel comfortable from the start and not need to be “broken in” or stretched by wearing
close monitoring when starting to wear new shoes and/or insoles
Advice for shoe fitting:
When you get the shoes home (3)
wear new shoes for 1 hour and then thoroughly check feet for any signs of pressure
if any concerns, stop wearing shoes and have problems addressed
do not continue to wear shoes that cause blisters, corns or sores
Three types of specialty shoes
Accommodative shoes
have extra depth or width to fit extra wide feet or toe deformities
Modified shoes
altered to accommodate foot deformity or improve gait
Custom shoes
created exclusively to fit a severe foot deformity that cannot be managed with modification
Slippers:
3 points of advice
ideally slippers should fit and give the same support as is needed for that client’s regular shoes
avoid slippers that are too tight or slip off too easily
washable slippers if they are worn without socks
Footwear Assessment:
The first thing to AX is?
Why is this relevant?
What else should you take note of?
how mobile a client is and how much ambulation and activity they do
the footwear needed for someone who is ambulating only short distances indoors will differ from someone who works as a letter carrier full-time
if they have any gait abnormality
Footwear Assessment:
examine the client’s feet and note? (2)
presence and location of any callus or skin breakdown
presence and location of any foot or toe deformity
Footwear Assessment:
examine the shoes and note? (8)
Style 1 Fit 1 Fastening 2 Wear 2 Lining 2
is the style of the shoe appropriate for that client needs?
does the shoe fit properly?
is the client able to fasten the shoes properly?
are the shoes or laces/velcro worn out?
is the shoe worn on the inside?
is the sole worn more in one place than another?
is the lining loose or bunched up?
is the shoe rubbing anywhere?
Footwear Assessment:
once your examination is completed? (6)
discuss your findings with the client
highlight any areas of concern
with input from the client, discuss how any problems might be realistically solved
make referrals as needed
document the plan of care including education and referrals
follow-up plan of care at subsequent visits
When Referral is Beneficial
Skin breakdown (4)
PAIN
DEFORMITY
callus build-up that is not manageable with regular foot care appointments and suitable, well fitted shoes
callus that is due to a permanent gait abnormality
(e.g. leg length discrepancy)
callus in a client with peripheral neuropathy, particularly plantar surface callus
any skin breakdown that is not managed with properly fitted footwear
ongoing foot pain that is not alleviated with properly fitted, supportive footwear
foot deformity that cannot fit properly into a regular show
Health Team Members for Management of Foot Deformity or Foot Pain
POP POP!
Physician Orthopedic Surgeon Podiatrist Pedorthist Orthotist Physiotherapist
Health Team Members for Management of Foot Deformity or Foot Pain
Physician: (4)
order x-rays and tests to rule out diseases
Dx the cause of foot pain or disease
Rx for special footwear and/or orthotics
Rx medications needed to treat foot pain or disease
Health Team Members for Management of Foot Deformity or Foot Pain
Orthopedic Surgeon: (5)
order x-rays and tests to rule out diseases
Dx the cause of foot pain or disease
Rx for special footwear and/or orthotics
Rx medications needed to treat foot pain or disease
perform lower limb surgery to treat, manage or correct bone disorders
Health Team Members for Management of Foot Deformity or Foot Pain
Podiatrist: (6)
Dx 2
Rx 1
Manage 2
Perform 1
Dx the cause of foot pain or disorders
Dx and manage severe nail pathology
manage gait disorders
manage severe foot deformity e.g. rheumatoid arthritis, Charcot foot
Rx and fabricate splints, orthotics or other devices used to manage foot problems
perform nail surgery using local anesthetic
Health Team Members for Management of Foot Deformity or Foot Pain
Pedorthist: (5)
Ax conditions and disorders of the lower limb including gait disorders and plantar foot pressure
properly fit footwear to accommodate foot deformity
modify or create footwear if needed to fit
modify or create orthotic appliances used to manage pain and improve or assist function of the lower limb (i.e. custom molded orthotics)
needs a physician’s order with diagnosis and therapy indicated for orthotics
Health Team Members for Management of Foot Deformity or Foot Pain
Orthotist: (7)
design, create, fit and repair any device that is used to support, align or correct the function of a part of the body (includes all braces, splints or foot orthotics)
make custom molded insoles using a plaster model of client’s feet
uses mathematically calculated formulas to displace areas of high pressure over a larger surface and thus reduce the pressure in a problem area of the foot
modify shoes to ensure they accommodate the orthotics
gait analysis
measure and manage leg length discrepancy
needs a physician’s order with diagnosis and therapy indicated for orthotics.
Health Team Members for Management of Foot Deformity or Foot Pain
Physiotherapist: (4)
complete independent assessment of all mobility issues
gait analysis and measure leg length discrepancy
wide range of treatments to improve movement and modify pain exercise massage ultra sound heat/cold acupuncture
Some physiotherapists create and modify orthotics
Shoe modifications to assist with mechanical offloading
Rocker bottom soles Balloon patching Flare Buttresses Extended Steel Shank Metatarsal Bars
Shoe modifications to assist with mechanical offloading
Rocker bottom soles
Used to: (3)
used to:
reduce pressure and impact shock to affected areas
immobilize metatarsal joints
help weight transfer from heel strike to push off
Shoe modifications to assist with mechanical offloading
Balloon patching
Used to…
By…
used to
reduce pressure and shear from affected areas of the foot (other than the plantar surface)
by
cutting a hole in the shoe around the sight and replacing with a large soft patch
Shoe modifications to assist with mechanical offloading
Flare (AIR)
Adhered to
Used to…(2)
adhered to the soles and heels of shoes
Used to
accommodate deformity
improve weight transfer
or
reduce pronation and abduction
Shoe modifications to assist with mechanical offloading
Buttresses
Describe
Used to…
For who?
an extension added to the side of the shoe including both the sole and the upper
provides
MORE extension stabilization than a flare.
for
MORE severe
medial or lateral instability
of the mid or hind foot
Shoe modifications to assist with mechanical offloading
Extended Steel Shank
steel bars used with the rocker sole to remove all movement and shearing in the shoe
Shoe modifications to assist with mechanical offloading
Metatarsal Bars
Describe
Used for…
extended bars made of strong neoprene material put on the soles of shoes to give the same results as a rocker sole.
Often used for more suitable for dressier types of shoes and may also be proximal to the affected joint
Resources for Footwear and Orthotics
Podiatrists
The College of Podiatrists of Manitoba
Online resource for the public and members of the College of Podiatrists of Manitoba
Has a contact list of all Podiatrists currently practicing in Manitoba
For Footwear, Orthotics, Pedorthists or Orthotists
Associations (2)
Canadian Association for Prosthetics and Orthotics
Pedorthic Association of Canada (PAC)
For Footwear, Orthotics, Pedorthists or Orthotists
Look in telephone directory Yellow Pages under headings:
Artificial Limbs
Foot Appliances
Orthopedic Appliances
Tips on financial assistance for footwear and orthotics:
Private insurance plans such as?
Blue Cross
Veteran’s Benefits
Tips on financial assistance for footwear and orthotics:
Private insurance plans
Coverage
check individual plan coverage
usually needs pre-approval
coverage for shoes only if they are doctor prescribed and custom made
full or partial coverage for molded or custom orthotics
no coverage for stock shoes
no coverage for stock insoles
Tips on financial assistance for footwear and orthotics:
Assistance such as? (3)
Social Assistance
FNIB (Treaty Benefits)
some Treaty Bands
Tips on financial assistance for footwear and orthotics:
Assistance
Coverage
needs pre-approval
might provide some assistance for foot care, footwear and orthotics
ask a Case Manager or Social Worker if involved
