the singing podiatrist.com

he foot stuff

padding

The use of felt padding on the foot and in shoes is probably one of the most practical and at times miraculous skills that podiatrists bring to foot care. This is considered by some to be one of the "old-fashioned" treatment options. I remember in podiatry school, we spent an afternoon with a retired podiatrist, who I think was over 80. He was a wizard with felt and gave us a wealth of information on how to use this magic material.

Off-Weighting
Anywhere on the foot where there is pain, there is usually too much pressure landing on that part of the foot. Typical examples include the sesamoids (under the big toe joints), metatarsal heads, bunions, hammertoes and bony prominences. The concept of off-weighting simply removes excess pressure from a painful area. The pressure may come from the floor (through the shoe) or it may come from the side or top of a shoe. Felt is used in different thicknesses and it is adhesive backed. In order to off-weight you have the felt must be placed in the proper area. Felt is never placed directly over a painful area - for example, on top of a callous. One must be careful that in the process of off-weighting a painful area, pressure isn't shifted to another sensitive area.

One of the most common foot problems that this works for is sesamoiditis - common in dancers. The sesamoids are 2 small bones under the big toe joint. They easily become irritated during dancing where the weight is mostly on the ball of the foot. An off-weighting felt pad technique is used to reduce the pressure under the sesamoids. Some people need the padding for a short time only and others need it for the long term. The padding can be placed on the skin, on a shoe insole or be incorporated into an orthotic. Brilliant! And it almost always works.

Metatarsal pads are a common method of off-weighting. They are used for metatarsal head pain, but often they are unsuccessful. Sticking a thick piece of material up into the arch in an attempt to relieve pressure on the ball of the foot just doesn't work for alot of people. For one thing, the metatarsal heads are all joined together by a thick ligament. It is not possible to isolate one metatarsal head and elevate it. A metatarsal pad can be useful in some situations and it must be placed in the correct position. It must be done carefully and with understanding of the biomechanics of the entire foot.

Some callouses on the bottom of the foot will not respond to padding of any kind. In order to effectively lift weight off a callous, a substantial shift in weightbearing pressure must occur. This can rarely be done simply with padding. Combining padding with orthotics and/or shoe modifications can often be more successful. In order to evaluate why a callous has formed, a thorough biomechanical evaluation must be performed. There are so many possibilities. Many callouses can be eliminated with effective padding techniques combined with other treatment options. Surgery is sometimes recommended and should be considered a last resort. After all conservative options have been exhausted, surgery may be the best approach.

Is it possible to use padding to treat a bunion? In some situations, perhaps. Some people have pain in their bunion joint and others have pain caused by shoe pressure on the joint. If the problem is simply shoe pressure pain, then padding may be effective. Padding always goes around the painful area and must be thick enough to transfer pressure off the bunion. There are a multitude of bunion correcting and protecting devices in most drug stores. You may want to purchase one and have it evaluated by a podiatrist. Some of these devices may actually worsen the problem. You have to be very careful that you don't cause new problems by wearing protective pads and trying drugstore devices.

Bony prominences can appear in many areas on the foot, for many reasons. The most common are bunions, hammertoes, arch bumps on the top of the foot, heel bumps, and prominence at the base of the 5th metatarsal (styloid process). People with progressive arthritis or traumatic injuries are more likely to have significant bony prominences, often painful. People with high arches also tend to have more bony bumps. A very common problem is a bump on the back of the heel, also called "pump bumps". People who get these bumps have a genetic prominence on the back of the heel bone which over the years becomes more and more prominent due to friction from shoes. Women who wear pumps are more likely to develop these. Once they develop, they cannot be reversed, except with surgery. Unfortunately, the achilles tendon attaches in the same area as the bump and therefore surgery is rarely recommended because of potential complications. There are some excellent padding techniques for this particular problem.

Some people have curly toes or hammertoes. These can develop in people with high arches or they can be genetic. They are common in people with arthritis and neurological disorders, including strokes. Often hammertoes develop because the foot is unstable and the toes grip the ground in an attempt to improve stability. The best approach in this case is to use a proper orthotic or shoe to improve stability and let the toes relax and do what they're supposed to do. Once the foot is stabilized and shoes are evaluated to ensure a deep toe box, the hammertoes can be padded if necessary. This can be done in a variety of ways. Acid pads bought at the drugstore are not generally recommended. They can cause excess skin breakdown and lead to infections and often, they don't provide any longterm relief.

Diabetic Ulcerations

In people with longstanding diabetes, ulcerations can occur. An ulceration is a wound that will not heal. It can be superficial on the skin or it can go very deep, sometimes to bone. The reason why some diabetics get ulcerations are multiple. There is usually a combination of poor blood sugar control. loss of sensation, loss of normal circulation, lack of awareness of the body and structural deformities that create bony prominences. A diabetic ulceration could start from something as simple as an ingrown toenail. Off-weighting techniques using padding and sometimes casting are absolutely essential to promote wound healing. Wounds always take longer to heal if there is pressure on them. Because diabetics have difficulty healing anyway, the pressure-off padding techniques are absolutely essential to promote healing of wounds. Any diabetic with any ulceration should be seeing a podiatrist to learn about these techniques. In fact, all diabetics should have a podiatrist who they see regularly in order to prevent this complication.

Summary

Padding of the foot in order to treat various foot problems can be extremely effective. Padding techniques work best for bony prominences, hammertoes, sesamoiditis, metatarsal head pain, callouses, bunions and diabetic ulcerations or wounds that will not heal. It is important to be evaluated by a podiatrist to determine if this treatment option could work for you.