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Post by dtt on Nov 23, 2008 21:17:08 GMT
Hi Karen Yes that is always a danger unless you check your patients circulation and sensory perception BEFORE APPLICATION of any caustic substance. As I said in my reply previously , remove the cause and effect a cure = offload it Cheers Derek
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Post by dawnbacon on Nov 25, 2008 19:29:44 GMT
Dear All, New to the forum (first post, so be gentle folks!).
If the interdigital HM is due to the 5th toe "burrowing" into the lateral aspect of the 4th I usually approach the problem from a biomechanical view. An assessment of foot function and footwear may well prove fruitful. Often excessive sub-talar joint pronation can compromise the quadratus plantae function - effectively resulting in an adducto-varus "pull" on the lesser digits (particularly 4 and 5). Hope this helps D
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Post by dtt on Nov 25, 2008 20:09:07 GMT
Hi Dawn Well done on your first post and Welcome to the Forum Generally we are "gentle" ( except with Trolls ) on this site so feel free to express your views and share your knowledge and learn from others. The first of many posts I hope. Its a great site ENJOY Cheers D
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Post by blinda on Nov 25, 2008 22:29:15 GMT
Hiya Dawn!
Good to see you posting. Agree with your comments 100% on examining biomech status along with footwear. I`m a firm believer in addressing cause not just symptoms.
Cheers, Bel
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ronm
Full Member
but a simple man working against insurmountable odds
Posts: 141
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Post by ronm on Nov 26, 2008 15:34:10 GMT
Hi Karen I've always found that a little granuflex is great other alternatives are comfeel, newer dressings alevyn thick and thin secured with a bit of tape. do you not find these, particually the hydrocolloids, increase the maceration of the area
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Post by robertisaacs on Nov 27, 2008 10:11:50 GMT
Hey dawn Now you're talking my language! ;D Welcome indeed! Quadratus Plantae is a muscle to which not enough attention is paid. Definitly the unsung hero of the foot musculature. Pause for everyone to check their anatomy textbook and remind themselves where and what it is . This might help en.wikipedia.org/wiki/Image:Gray444.png#filelinksI would wholeheartedly agree that the angle of pull on the digits is strongly infulenced by the morphology / function of the foot. The actual effect of QP is a mare to assess, its deep and hard to examine without imaging equipment. However try this for a chain of deductive reasoning. The FDL muscle run just inferior to the medial malleolus and Superior to the Tibialis posterior. In a foot which is pronated (at any given moment) this structure deviates medially especially in a foot with a transverse dominance (drift lots drop little) This increases the angle of the force of the fDL relative to the midline of the foot. The QP, whose function it is to alter the vector of force would have no work to do in a foot where the flexor pulled paralell to the midline. As the angle increases the requirements on it increase concordantly Therefore, the requirements on the QP is proportionate to the degree of pronation (specifically the lateral deviation element of it) multiplied by the amount of flexor activity. Of course any such chain of logic is subject to flaws, however it raises some ineresting questions does it not? This muscle is not present in everybody, it would be fascinating to compare foot morphology between those who have it and those who do not! Might have to transplant this to biomechanics. Regards Robert
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Post by blinda on Nov 27, 2008 10:48:42 GMT
Ok, all that`s logical (and actually very interesting i hate to admit), but HOW could we compare morphology between those with a QP and those who don`t? Is there a clinical assesment that can be utilised to first see if it is present?
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Post by dawnbacon on Nov 28, 2008 18:42:09 GMT
Dear Robert, Yep follow your logic here, all except:
"The QP, whose function it is to alter the vector of force would have no work to do in a foot where the flexor pulled paralell to the midline"
Origin, entry point into the foot and insertions of FDL mean that without the correcting/balancing influence of QP the force vector of FDL will be oblique- it would be an unusual foot if FDL were able to pull paralell to the midline. Excessive or inapropriately timed pronation and/or flexor substitution would all work to compromise QP function thus rendering it unable to alter the force vector of FDL - end effect adducto-varus lesser digits, interdigital lesions and an unhappy patient.
(I have not managed to find the "Quote" function yet - apologies for my techno-retard state!) Best regards, D
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Post by dtt on Nov 28, 2008 19:18:41 GMT
Hey Dawn Great reply to the thread Robert has movedall of this part of the thread to the Biomechanics thread on the main site so I'm sure he will move your reply there. Highlight the part you want to quote ,copy and paste it into your message and highlight it again. Click on the quote icon above (second in from the right bottom line the page with the blue arrow on it ) click... Job Done Cheers D
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ipod
Junior Member
Posts: 55
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Post by ipod on Nov 28, 2008 19:37:02 GMT
I am glad to see that the thread can be restored to the original posters request for help with treating HM4/5- all the anatomy is very interesting but not exactly what the poster requested- I cannot say how in-depth the FHP course would delve into anatomy and biomechanics, but I suspect it would have been a little overwhelming, so much better to discuss it on a biomechanics thread .
There are certainly patients who present with interdigital HMs who do not pronate . It may be a case of inappropriate footwear, it may be that they have fixed toe deformities, or even just a toe shape whereby the 5th toe is very much shorter than the 4th toe. For those patients, the most convenient form of pressure relief to separate the toes is usually enough to prevent recurrence , be that a silicone device, a gel seperator or foam tubing- some patients fare better with one better than another. And of course footwear advise although that can be like taking a horse to water but not being able to make it drink! If the patient is not willing to comply, you will not get a permanent resolution.
Ipod
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10feet
Junior Member
Posts: 68
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Post by 10feet on Nov 28, 2008 21:33:10 GMT
Ipod
I agree, lets lose the technogarb and get back to practical support.
For my 1st posting, I wanted to say that however I try to apply my podiatric knowledge gained over the last 25 years; no matter what biomechanical intervention I apply to interdigital pathologies there is always a percentage who return their orthoses and silicones prefering a cotton wool pad which works far better.
Who am I to argue?
10feet Pete (Smith)
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Post by robertisaacs on Nov 28, 2008 22:07:36 GMT
Hmmm. I think the biomechanics of lesser digit funtion is quite germaine to the OP. However it is certainly biomechanics so it does indeed belong there.
Fully agree on all points! There are all sorts of Causes for ID corns. Of which incompetant quadratus plantae function may well be one but is certainly not the only one!
Hey pete, welcome to the forum!
Not sure i would describe it as technogarb, just good terminology. Tehnical and practical are not exclusive!
Ah cotton wool. Much under rated. I tend to agree. As ipod pointed out there are all sorts of causes of raised ID pressure, some will respond better to the simple things.
And, of course, its cheap and easily accessable!
Regards Robert
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10feet
Junior Member
Posts: 68
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Post by 10feet on Nov 29, 2008 7:24:36 GMT
Thank you kindly for your welcome, Robert. It is much appreciated.
New to the forum, I assumed that the originator was seeking help as a FHP, as they'd posted under a dedicated forum. Ipod's timely input just pulled the focus back round to the origins of the request.
I very much appreciate your good terminology but a part of the teaching process is for the student to be able to understand the underpinning knowledge of the foot, the concept and to explain to the patient in extremely simple terms, the problem, before reaching a solution.
However important forums are in the teaching process for our FHP colleagues, there comes a point when it is sensible to advise seking assistance from someone gifted with more knowledge such as yourself.
It is at this point I would be advising that the originators treatment plan is perhaps not working and referral with consideration to the biomechanical causes of the underlying problem could be explored more appropriately with a PCT referral to an MSK Specialist Podiatrist.
There is a point within my own practice when I call a halt to my own treatment plan and bring on board more specialist help. This brings appreciation from the patient and increased goodwill.
I assume you have advised, somewhere on the forum, this possibility?
With sincerity,
10feet Pete (Smith)
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Post by robertisaacs on Nov 29, 2008 7:55:51 GMT
An elegant and intelligent reply. I conceed the point. As you and iPod point out the biomechanics is on the biomechanics thread if anyone is interested (and I hope they will be ) Again, welcome! Kind regards Robert
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Post by dawnbacon on Nov 30, 2008 14:27:25 GMT
Dear All, Apoligies if I diverted the thread into biomechanics (my area of clinical focus) - intention was to help illuminate some of the possible causes of the interdigital corn (though of course I accept that this is just one possibility).
I agree wholeheartedly that if local, palliative measures do not work it is definately appropriate to refer on.
WBW Dawn
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