Debriding – Shaving or Debriding – Calluses and Nails

This is an interesting discussion on Present Podiatry about the importance of debriding calluses or nails. As pointed out by several of the podiatrists, they use the debridement session as an opportunity to examine the callosity or nail more closely. As one practitioner noted, an examination after debridement of a callus can often expose an early stage diabetic foot ulcer under a callus.

Kathleen Satterfield, DPM, leads the discussion. In an earlier post, we compile some resources on Callus Debridement or Shaving of the Diabetic Foot.

Sign up for the American Academy of Orthotists & Prosthetics Diabetic Foot Workshop

It’s not too late to sign up for the Friction Management Workshop at AAOP in Chicago!!

The American Academy of Orthotists and Prosthetists 36^th Annual Meeting and Symposium is coming up soon – Feb 24-27, 2010 in Chicago, Illinois. You can view the program at www.academyannualmeeting.org.

If you see patients with diabetic / neuropathic foot problems and are looking for an edge in ways to address commonly seen problems, please consider signing up for Technical Workshop 33 titled “Diabetic Foot Problems and Novel Ways to Treat Them with ShearBan” on Wednesday 24 February, 2010. The workshop will discuss the biomechanics of the diabetic/neuropathic foot, footwear, pedorthic/orthotic interventions, and friction science. Workshop participants will have the opportunity to install ShearBan using a variety of techniques. The presenters will be Dennis Janisse, C.Ped from National Pedorthic Services, Inc. and Mark Payette, CO from Tamarack Habilitation Technologies.

“Plantar Shear Stress Distribution in Athletic Individuals with Frictional Foot Blisters”

This is the title of a forthcoming research article from two researchers at the Lerner Research Institute – part of the Cleveland Clinic. Doctors Metin Yavuz, PhD, and Brian L. Davis, PhD, are the co-authors. Doctors Davis and Yavuz have done extensive research over the past 10 to 15 years on measuring shear and pressure on the plantar surface of the feet of many different populations: athletes, people with diabetes, children, and the elderly. The article will appear in the Journal of the American Podiatric Medical Association.

Shear is increasingly becoming a major research topic for clinicians treating and preventing problems ranging from blisters to diabetic foot ulcers.

Callus Debridement or Shaving of the Diabetic Foot

Calluses are a particular problem for people with diabetic peripheral neuropathy. An earlier post entitled Callus Prevention on Diabetic Feet through Friction Reduction explores in greater depth why callusing poses a risk.

One way to deal with calluses on the diabetic foot is debridement. However, debridement of calluses should only be undertaken by a healthcare professional because of the danger of injury to the insensate foot.

This instructional video on Callus Debridement from Indian Health Services, division of Diabetes Treatment and Prevention, provides clear guidance to the clinician on callus debridement. In the video note especially the soft, mushy center of the callus exposed by the shaving. As the narrator points out, this is a typical location where a pre-ulcerative lesion can form.

To make callus debridement a little easier and less risky, use ShearBan® in-between debridement sessions. ShearBan can be positioned on footwear opposite the callus. By reducing friction and shear loading, ShearBan can slow callus formation and reduce the amount of tissue that has to be removed.

Keywords: foot, feet, ulcer, lesion, ulceration, neuropathic foot, diabetic peripheral neuropathy, shear, pressure, peak pressure; callus, calluses, callous, callouses, hyperkeratosis, hyperkeratotic, callosities, callosity, debridement, shave, pare, shaving, paring.

Get your Tamarack Product Guide Today

If you’ve been using Tamarack Flexure Joints™ in your practice to fabricate custom orthotic-prosthetic devices for clients, we hope you’ll request a copy of our new Tamarack Flexure Joint Fabrication Guide.

Complete with nearly 30 pages of full-color images and detailed instructions, the Tamarack Guide will assure every ankle-foot orthosis (AFO) and other lower or upper extremity orthosis is fabricated for optimal performance.

Order your FREE COPY of the Tamarack Flexure Joint™ Fabrication Guide today.

Simply e-mail info[at]tamarackhti.com with your name & mailing address.

To download or print an electronic copy of the Tamarack Guide, visit www.tamarackhti.com or click here.

English and Spanish translations available. Additional translations coming soon.

Plantar Shear – New Research

Researchers at the Cleveland Clinic did a small pilot study looking at shear reducing diabetic insoles worn by healthy subjects. Their hypothesis was that if shear reduction works with these insoles, step length should be shortened. Matassini et al. Do shear reducing diabetic insoles really reduce plantar shear? The paper is being presented on October, 2010, at the conference: A Team Approach, Diabetic Limb Salvage, Georgetown University Hospital. Presumably, step length decreases if plantar shear is reduced because gait is less efficient. In their pilot study, the investigators found, however, that the shear reducing insoles did not reduce step length.

The results from this pilot don’t surprise us. The shear reducing insoles presently on the market attempt to reduce shear over large areas of the plantar surface. If they truly were effective at reducing shear, they also would make gait inefficient because the foot would be sliding around in the shoe.

The best way to reduce shear on the plantar surface is to use targeted friction management. Not all friction and shear are bad. In order to have efficient gait, friction and shear are necessary. By targeting friction and shear reduction just to problem areas, gait efficiency can be maintained while still protecting the foot. This is the advantage of a product like ShearBan®. The ShearBan patch can be placed by the clinician at the location of shear trauma.

How does one know where to target friction relief? For both the diabetic foot and the healthy foot the answer is pretty straightforward: look for locations of heavy callusing. Friction and shear cause the callusing, and research shows that the locations of heavy callusing are where diabetic foot ulcers typically occur. Murray et al. 1996. Therefore, put the ShearBan patch on the footwear opposite the areas of heavy callusing.

Seeking Staff Engineer with Orthotic-Prosthetic or Pedorthic Experience

Tamarack Habilitation Technologies, Minneapolis, MN is seeking an engineer to assist with new product development, product & technology research and product manufacturing processes. Position requires candidate to work as a project lead as well as assist other project leads as directed. Candidate will support general engineering needs for production and facilitation repairs or changes. This position requires a Bachelor of Science degree, preferably in mechanical, biomechanical, or biomedical engineering. Experience or education in orthotics, prosthetics, or pedorthics is preferred, with three to seven years work experience.

Email resume to info[at]tamarackhti.com or fax: (763) 795-0058

Articulating Ankle Foot Orthosis (AFO) for Treating Patient with Stage II Posterior Tibial Tendon Dysfunction – Case Report

A recent case study compared three ankle foot orthoses for treating posterior tibial tendon dysfunction (PTTD) also known as adult acquired flatfoot. Neville CG, Houck JR, Choosing among 3 ankle-foot orthoses for a patient with stage II posterior tibial tendon dysfunction, J Orthop Sports Phys Ther. 2009 Nov;39(11):816-24. The case study considered a custom non-articulating AFO, an off-the-shelf AFO, and a custom articulating AFO. The custom articulating AFO was an Arizona AFO using a Tamarack™ Flexure Joint.

Based on gait analysis, the study found that the custom articulating AFO “was associated with the greatest change in flatfoot deformity.” In addition, the patient felt it produced the greatest correction in foot deformity. Therefore, the study concluded that the custom articulating AFO using the Tamarack Flexure Joint was “optimal” for the patient.

Tamarack Flexure Joint™ Molding Dummy Improvements

The tooling for making the molding dummies for Tamarack Flexure Joints^™ and Tamarack Dorsiflexion Assist Flexure Joints^™ was replaced this fall. This gave us the opportunity to make some minor improvements. We’ve designed the new tooling to produce the parts more efficiently, and were very careful not to change the shape or size of the dummies.

• Cores were added to the underside to improve the injection molding process in order to keep costs from rising.
• A stand-off pad was added to the center of the dummy to prevent it from bending during the vacuum forming process.
• No changes were needed or made to pediatric size dummies.

In-house testing of the new Tamarack^™ Molding Dummies revealed that the cavities conformed precisely to the Tamarack Flexure Joints^™. We also found that the joint clearance space was better preserved because of the newly added stand-off pad.

This may be just a small change, but we think it will make the fabrication process a little easier; and the performance of your finished product a little better.

For more information about Tamarack Flexure Joint™ Fabrication, consult our new Flexure Joint Fabrication Guide.

We appreciate your feedback!

If you have any questions or comments about Tamarack^™ products, please contact us!

Follow Tamarack Habilitation Technologies on Twitter

If you’re a Twitter user, we hope you’ll follow @TamarackHTI to stay current with news about Tamarack Habilitation Technologies, Inc., Inside Tamarack blog posts, and other orthotic/prosthetic, pedorthic, podiatry and friction management news.

We have a lot of exciting product updates & launches in store for 2010. We look forward to hearing from our customers!

For more information about Tamarack^™ products, visit www.tamarackhti.com.