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Foot - HIGH RISK Feet > Unit 4 - Foot Health Team Management of Foot Deformity > Flashcards

Unit 4 - Foot Health Team Management of Foot Deformity Flashcards

1
Q

Socks

Function of socks (4)

A

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

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2
Q

Socks

Types of sock fibres

How do the fibres differ?

A

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

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3
Q

Socks

Which type is best?

A

there is no strong evidence that one fibre or type of sock is truly superior to another

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4
Q

Advice to clients about socks:

Fit (4)

A

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

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5
Q

Advice to clients about socks:

Condition (2)

A

darning or mending socks will create unwanted pressure points

discard socks with holes

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6
Q

Advice to clients about socks:

Hygiene (3)

A

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

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7
Q

Advice to clients about socks:

Seams (2)

A

bulky seams can create points of pressure on fragile skin

some people wear their socks “inside out” to minimize pressure of seams

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8
Q

Shoes MUST be…

Shoes MUST

A

FUNCTIONAL

FIT

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9
Q

What do FUNCTIONAL shoes do? (4)

A

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)

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10
Q

Advice for shoe fitting:

What type of shoe is suitable for most people?
What type of closure and why?
Upper
Sole (3)
Arch
Heels
A

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

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11
Q

Advice for shoe fitting:

Shoes must fit in all three directions…tell me more.

A

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

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12
Q

Advice for shoe fitting:

While looking at shoes in the store (4)

A

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

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13
Q

Advice for shoe fitting:

When you get the shoes home (3)

A

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

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14
Q

Three types of specialty shoes

A

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

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15
Q

Slippers:

3 points of advice

A

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

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16
Q

Footwear Assessment:

The first thing to AX is?
Why is this relevant?
What else should you take note of?

A

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

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17
Q

Footwear Assessment:

examine the client’s feet and note? (2)

A

presence and location of any callus or skin breakdown

presence and location of any foot or toe deformity

18
Q

Footwear Assessment:

examine the shoes and note? (8)

Style 1
Fit 1
Fastening 2
Wear 2
Lining 2
A

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?

19
Q

Footwear Assessment:

once your examination is completed? (6)

A

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

20
Q

When Referral is Beneficial

Skin breakdown (4)
PAIN
DEFORMITY

A

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

21
Q

Health Team Members for Management of Foot Deformity or Foot Pain

POP POP!

A 
Physician
Orthopedic Surgeon
Podiatrist
Pedorthist
Orthotist
Physiotherapist
22
Q

Health Team Members for Management of Foot Deformity or Foot Pain

Physician: (4)

A

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

23
Q

Health Team Members for Management of Foot Deformity or Foot Pain

Orthopedic Surgeon: (5)

A

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

24
Q

Health Team Members for Management of Foot Deformity or Foot Pain

Podiatrist: (6)

Dx 2
Rx 1
Manage 2
Perform 1

A

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

25
Q

Health Team Members for Management of Foot Deformity or Foot Pain

Pedorthist: (5)

A

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

26
Q

Health Team Members for Management of Foot Deformity or Foot Pain

Orthotist: (7)

A

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.

27
Q

Health Team Members for Management of Foot Deformity or Foot Pain

Physiotherapist: (4)

A

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

28
Q

Shoe modifications to assist with mechanical offloading

A 
Rocker bottom soles
Balloon patching
Flare
Buttresses
Extended Steel Shank
Metatarsal Bars
29
Q

Shoe modifications to assist with mechanical offloading

Rocker bottom soles

Used to: (3)

A

used to:

reduce pressure and impact shock to affected areas

immobilize metatarsal joints

help weight transfer from heel strike to push off

30
Q

Shoe modifications to assist with mechanical offloading

Balloon patching

Used to…
By…

A

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

31
Q

Shoe modifications to assist with mechanical offloading

Flare (AIR)

Adhered to

Used to…(2)

A

adhered to the soles and heels of shoes

Used to

accommodate deformity

improve weight transfer

or

reduce pronation and abduction

32
Q

Shoe modifications to assist with mechanical offloading

Buttresses

Describe
Used to…
For who?

A

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

33
Q

Shoe modifications to assist with mechanical offloading

Extended Steel Shank

A

steel bars used with the rocker sole to remove all movement and shearing in the shoe

34
Q

Shoe modifications to assist with mechanical offloading

Metatarsal Bars

Describe
Used for…

A

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

35
Q

Resources for Footwear and Orthotics

Podiatrists

A

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

36
Q

For Footwear, Orthotics, Pedorthists or Orthotists

Associations (2)

A

Canadian Association for Prosthetics and Orthotics

Pedorthic Association of Canada (PAC)

37
Q

For Footwear, Orthotics, Pedorthists or Orthotists

Look in telephone directory Yellow Pages under headings:

A

Artificial Limbs
Foot Appliances
Orthopedic Appliances

38
Q

Tips on financial assistance for footwear and orthotics:

Private insurance plans such as?

A

Blue Cross

Veteran’s Benefits

39
Q

Tips on financial assistance for footwear and orthotics:

Private insurance plans

Coverage

A

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

40
Q

Tips on financial assistance for footwear and orthotics:

Assistance such as? (3)

A

Social Assistance
FNIB (Treaty Benefits)
some Treaty Bands

41
Q

Tips on financial assistance for footwear and orthotics:

Assistance

Coverage

A

needs pre-approval

might provide some assistance for foot care, footwear and orthotics

ask a Case Manager or Social Worker if involved

Foot - HIGH RISK Feet (6 decks)

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