Unit 5 - Advanced Nursing Foot Care Interventions Flashcards
Off-loading
reducing pressure by deflecting it away to an adjacent area or redistributing it over a larger area
Padding
the material used to deflect or redistribute the pressure
The basic mechanical principle of pressure says that…
pressure is equal to the total force per unit area
Formula for calculating pressure
Pressure (P)
Force (F) - in kilograms (person’s weight)
DIVIDED BY
Area (A) in sq cm
Unit the answer will be in
kg/sq cm
If a person weighs 75 kg and the area of their foot that is in contact with the ground is 4 sq cm (2 cm X 2 cm) the pressure equals:
Pressure =
Force 75 kg
DIVIDED BY
Area 4 sq cm
= 18.75 kg/sq cm
If the same weight is distributed over an area that is 16 sq cm (4 cm X 4 cm)
Pressure =
Force 75 kg
DIVIDED BY
Area 16 sq cm
= 4.69 kg/sq cm
This results in…
a reduction of 18.75 – 4.69 = 14.06 kg/sq cm
A warning about padding and footwear!
Warning!
If the footwear is not large enough to accommodate the padding, added padding could actually increase pressure and cause damage.
In this foot care course, use of padding will be limited to simple, commercially available, over-the counter products. The padding discussed will be …
products that relieve pressure on the toes, dorsum or sides of the foot.
In this foot care course, use of padding will be limited to simple, commercially available, over-the counter products. The padding discussed will be products that relieve pressure on the toes, dorsum or sides of the foot.
What about the plantar aspect of the foot?
Any change to plantar pressure with use of padding has the potential to alter gait, balance and stability drastically and must be managed by a professional trained to do so.
Any change to plantar pressure with use of padding has the potential to alter gait, balance and stability drastically and must be managed by a professional trained to do so, WHO?
Either an orthotist or pedorthist
Can a nurse make adjustment or modification to insoles?
Nurses doing adjustment or modification of insoles that change plantar pressure need
additional training
and
to be working as part of a team that includes an orthotist and/or pedorthist.
Safety Guidelines for the use of over-the-counter (OTC) Padding:
Shoes (3)
many problems of pressure on toes, dorsum or sides of the foot can be alleviated or managed with appropriately fitted shoes alone
properly fitted shoes must precede use of padding
the client must wear shoes that properly accommodate their feet AND have room for the padding
Safety Guidelines for the use of over-the-counter (OTC) Padding:
Self-care / Management @ home (2)
clients must be able to examine their feet or have a care-giver who can
clients must be able to apply and remove the device to clean or have someone that can help them
Safety Guidelines for the use of over-the-counter (OTC) Padding:
Indications / Contraindications (1)
use only for clients that have good circulation and no peripheral neuropathy
Safety Guidelines for the use of over-the-counter (OTC) Padding:
Proper use (2)
clients will usually not feel a padding device if it is properly fitted. Instruct clients to remove padding if it causes any discomfort
stop using a padding device if it does not have the desired effect after a period of trial (e.g. stop using a toe sleeve if it does not reduce the interdigital corn)
Safety Guidelines for the use of over-the-counter (OTC) Padding:
5 rules to regurgitate on a test
many problems of pressure on toes, dorsum or sides of the foot can be alleviated or managed with appropriately fitted shoes alone
properly fitted shoes must precede use of padding
clients must be able to examine their feet or have a care-giver who can
clients must be able to apply and remove the device to clean or have someone that can help them
use only for clients that have good circulation and no peripheral neuropathy
Where and When Referral is indicated:
Referral can be to ? (2)
a podiatrist
or
a pedorthist /orthotist with a prescription from a doctor
Where and When Referral is indicated: (5)
plantar callus build-up that is not managed with regular foot care and suitable, well fitted shoes
plantar callus in a client with peripheral neuropathy and/or poor circulation
callus that is due to a permanent gait abnormality (e.g. leg length discrepancy)
foot deformity that cannot fit properly into a regular shoe
any concern that does not respond to conservative treatment and is disabling in the client’s view
Types of Padding Used in Nursing Foot Care
Cotton ball or lamb’s wool - Describe. Used to?
easy to use padding
reduce friction between toes and absorb moisture
Types of Padding Used in Nursing Foot Care
Cotton ball or lamb’s wool - How often to change
Daily
Types of Padding Used in Nursing Foot Care
Cotton ball or lamb’s wool - Precaution?
if using lamb’s wool ensure that client is not allergic
Types of Padding Used in Nursing Foot Care
Toe separator - Describe. Used to?
gel or soft foam/plastic in varying sizes
reduce friction and pressure between toes
