Felt Padding Research Articles

Effectiveness and Duration of Plantar Pressure Off-loading by Two Designs of Felt Padding: A Preliminary Study.

The aim of this study was to observe the pressure changes in the felt padding used to off-load pressure from the first metatarsal head, the effects obtained by different designs, and the loss of effectiveness over time. With a study population of 17 persons, two types of 5-mm semicompressed felt padding were tested: one was C-shaped, with an aperture cutout at the first metatarsophalangeal joint, and the other was U-shaped. Pressures on the sole of the foot were evaluated with a platform pressure measurement system at three time points: before fitting the felt padding, immediately afterward, and 3 days later. In terms of decreased mean pressure on the first metatarsal, significant differences were obtained in all of the participants (P < .001). For plantar pressures on the central metatarsals, the differences between all states and time points were significant for the C-shaped padding in both feet (P < .001), but with the U-shaped padding the only significant differences were between no padding and padding and at day 3 (P = .01 and P = .02). In healthy individuals, the U-shaped design, with a padding thickness of 5 mm, achieved a more effective and longer-lasting reduction in plantar pressure than the C-shaped design.

The effectiveness of felt padding for offloading diabetes-related foot ulcers, at baseline and after one week of wear

AimFelt padding is used to offload diabetes-related foot ulceration although limited quality data exists to support its use. This study aimed to quantify pressure offloading from neuropathic plantar foot ulcers in a clinical setting, when felt padding is first applied and after wear. MethodsThis study used a within-subjects, repeated measures design. Data was collected in a high-risk foot service. Peak plantar pressures, contact area and contact time were measured in 15 diabetes subjects with 16 non-complicated plantar neuropathic foot ulcers, with: no felt padding, newly applied felt padding and felt padding after one week of wear. ResultsStatistically significant decreases in peak pressure of 49% and 32% were measured with newly applied felt padding (188.0kPa; p<0.001) and worn felt padding (248kPa; p=0.003) respectively, compared to no padding (367.2kPa). Worn felt offloaded 32% less pressure than new felt however this did not reach statistical significance (p=.069). Corresponding increases in contact area of 18% and 14% occurred with newly applied felt padding (156.9cm2; p<.001) and worn felt padding (150.6cm2; p=0.003) compared to no padding (132.5cm2). Contact time was constant across testing conditions. ConclusionsNew felt padding offloaded on average half the pressure applied to sites of plantar neuropathic ulceration, which reduced to one third after wear. Increased contact area under the foot is a possible mechanism contributing to pressure reduction. Further studies are required to evaluate effectiveness of felt padding directly on ulcer healing.

Three dimensional design, simulation and optimization of a novel, universal diabetic foot offloading orthosis

Leg amputation is a major consequence of aggregated foot ulceration in diabetic patients. A common sense based treatment approach for diabetic foot ulceration is foot offloading where the patient is required to wear a foot offloading orthosis during the entire treatment course. Removable walker is an excellent foot offloading modality compared to the golden standard solution - total contact cast and felt padding. Commercially available foot offloaders are generally customized with huge cost and less patient compliance. This work suggests an optimized 3D model of a new type light weight removable foot offloading orthosis for diabetic patients. The device has simple adjustable features which make this suitable for wide range of patients with weight of 35 to 74 kg and height of 137 to 180 cm. Foot plate of this orthosis is unisexual, with a size adjustability of (US size) 6 to 10. Materials like Aluminum alloy 6061-T6, Acrylonitrile Butadiene Styrene (ABS) and Polyurethane acted as the key player in reducing weight of the device to 0.804 kg. Static analysis of this device indicated that maximum stress developed in this device under a load of 1000 N is only 37.8 MPa, with a small deflection of 0.150 cm and factor of safety of 3.28, keeping the safety limits, whereas dynamic analysis results assures the load bearing capacity of this device. Thus, the proposed device can be safely used as an orthosis for offloading diabetic ulcerated foot.

Census Valachorum in mid-16th century upper Hungary

The Vlachs in mid-16th century Upper Hungary had different obligations than all other subjects of the feudal estate. The sum of all fiscal obligations of the Vlachs is summarized in the census of the Muraň castle estate, which always designates it under the name “ census Valachorum ”, a phrase that includes the delivery of sheep, lambs, quarks, or pieces of harness for horses. Their main obligation consisted in a number of sheep, lambs, and goats according to the size of their flock, which they delivered around the Pentecost. Another obligation typical of the Vlachs was the bellows cheese. For every flock was due a harness ( cinctorium ), named at times after its Hungarian equivalent, heveder . If this harness is common to a number of the feudal estates, on the Muraň castle estate it was supplemented by a wool fabric, called in Hungarian nemez , and in Latin subsellium , probably because it was used as felt padding for the horseback, under the saddle.

Use of Advanced Bleeding Control Mechanisms in Athletic Training: A Shift in the Thought Process of Prehospital Care—Part 1: Tourniquets

Two other competencies(Table 1), although not necessarily new to the list ofimmediate emergency management care skills, do requirefurther examination based on the current available scienceand standard of care in prehospital medicine. The purposeof this column is to provide athletic training educators(ATE) with evidence regarding the use of tourniquets in theprehospital setting as well as to be a resource on how toteach the management of external hemorrhage usingtourniquets.Trauma resulting in disruption of soft tissue is classified asan open or closed wound, and any significant loss ofintravascular volume may lead sequentially to hemodynam-ic instability, decreased tissue perfusion, cellular hypoxia,organ damage, and death.

A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers.

BackgroundOffloading is key to preventing or healing plantar neuropathic foot ulcers in diabetes. Total contact casts or walkers rendered irremovable are recommended in guidelines as first-line options for offloading, however the use of such devices has been found to be low. This study aimed to investigate offloading practices for diabetes-related plantar neuropathic ulcers.MethodsAn online survey of closed and open-ended questions was administered via SurveyMonkey®. Forty-one podiatrists experienced in high-risk foot practice, from 21 high-risk foot services around Australia, were approached to participate.ResultsThe response rate was 88%. Participants reported using 21 modalities or combinations of modalities, for offloading this ulcer type. The most frequently used modalities under the forefoot and hallux were felt padding, followed by removable casts or walkers, then non-removable casts or walkers. Participants indicated that many factors were considered when selecting offloading modality, including: compliance, risk of adverse effects, psycho-social factors, restrictions on activities of daily living, work needs and features of the wound. The majority of participants (83%) considered non-removable casts or walkers to be the gold-standard for offloading this ulcer type, however they reported numerous, particularly patient-related, barriers to their use.ConclusionsSelecting offloading for the management of foot ulceration is complex. Felt padding, not the gold-standard non-removable cast or walker, was reported as the most commonly selected modality for offloading plantar neuropathic ulceration. However, further evaluation of felt padding in high quality clinical trials is required to ascertain its effectiveness for ulcer healing.

A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers

BackgroundOffloading is key to preventing or healing plantar neuropathic foot ulcers in diabetes. Total contact casts or walkers rendered irremovable are recommended in guidelines as first-line options for offloading, however the use of such devices has been found to be low. This study aimed to investigate offloading practices for diabetes-related plantar neuropathic ulcers.MethodsAn online survey of closed and open-ended questions was administered via SurveyMonkey®. Forty-one podiatrists experienced in high-risk foot practice, from 21 high-risk foot services around Australia, were approached to participate.ResultsThe response rate was 88%. Participants reported using 21 modalities or combinations of modalities, for offloading this ulcer type. The most frequently used modalities under the forefoot and hallux were felt padding, followed by removable casts or walkers, then non-removable casts or walkers. Participants indicated that many factors were considered when selecting offloading modality, including: compliance, risk of adverse effects, psycho-social factors, restrictions on activities of daily living, work needs and features of the wound. The majority of participants (83%) considered non-removable casts or walkers to be the gold-standard for offloading this ulcer type, however they reported numerous, particularly patient-related, barriers to their use.ConclusionsSelecting offloading for the management of foot ulceration is complex. Felt padding, not the gold-standard non-removable cast or walker, was reported as the most commonly selected modality for offloading plantar neuropathic ulceration. However, further evaluation of felt padding in high quality clinical trials is required to ascertain its effectiveness for ulcer healing.

Providing wound management in an aged psychiatric facility

In January 2010, Podiatry staff at Caulfield Hospital were approached to provide a wound round at Caulfield’s Aged Psychiatric care facility, Namara. Staff at the facility acknowledged an increasing prevalence of foot wounds and a concern was raised by senior staff that the nursing staff had limited wound management knowledge and that it was difficult to transfer the residents to other sites for treatment. The Podiatry department introduced a 3 month Pilot Wound Round in January 2010, involving two Podiatrists and nursing staff from the facility to manage all foot wounds. It was imperative a member of the nursing staff was available at all times to assist with difficult residents. This also provided an opportunity for them to be educated about appropriate wound management skills; including choice of appropriate wound dressings, identifying infection and pressure care. The goals of podiatry intervention were to: (i) identify all foot wounds via referral and manage them on site on a weekly basis to maintain continuity and reduce healing times, (ii) provide treatment on site (nursing staff must accompany residents for any off-site appointments), (iii) educate nursing staff to identify pressure areas and make appropriate referrals, (iv) educate staff about the management of the high risk foot including wound management, pressure care and dressings, (v) improve management of foot complications, (vi) advocate for better access to dressings and equipment for the residents. At the commencement of the round seven wounds were present amongst the 30 residents and after 3 months this number was reduced to 3. Significant improvements were seen with the use of appropriate off-loading care such as felt padding, dressing choice, early referral and strategies to aid prevention. There was also a high focus on continuity of dressing regimes which we audited on a regular basis. Towards the end of the three month pilot, all dressing regimes put in place were being followed appropriately. Limitations to outcomes of the round to date have included the staffs’ knowledge in wound management practice. Whilst one staff member was nominated to attend the wound round with us on a weekly basis, other staff members who attend to dressing changes during the week have not benefited from the Podiatrists expertise. Other barriers have included learning to deal with the often difficult population group with mental illness. Compliance levels varied significantly and overcoming this was often challenging. In conclusion, the wound round has shown to be a cost effective means of reducing the burden of foot related complications in the Aged Psychiatric sector and this pilot has improved awareness and management in the prevention, early identification and management of foot wounds.

Preliminary investigation on the reduction of plantar loading pressure with different insole materials (SRP – Slow Recovery Poron ®, P – Poron ®, PPF – Poron ® + Plastazote, firm and PPS – Poron ® + Plastazote, soft)

Background The aim of this study is to investigate the amount of pressure reduction for different padding and insole materials commonly used in the podiatry clinic. Methods Plantar pressure were taken for 5 subjects without insoles fitted (BF) in their daily sports shoes, and thereafter with 4 pairs of simple insoles (6.4 mm thick) each as follow: SRP – Slow Recovery Poron ®, P – Poron ®, PPF – Poron ® + Plastazote (firm) and PPS – Poron ® + Plastazote (soft). In addition, subjects were also tested with semi-compressed felt (SCF) padding with a 1st metatarsophalangeal joint (MTPJ) aperture cut-out bilaterally. Minimum, maximum, mean pressure and peak pressure at the hallux, 1st, 2nd, 3rd/4th and 5th MTPJ across both feet were analysed. Repeated measures ANOVA with post hoc Bonferroni paired wise comparison was used to test for any statistical significance at the 95% confidence level for all pressure data. Results PPF was significant in reducing the minimum ( p < 0.005) and mean pressure ( p < 0.03) when compared to BF. This accounted for approximately 28% and 27% pressure reduction in minimum and mean pressure respectively. Peak pressure on the 1st MTPJ locality showed significant reduction of 37% and 29% with the use of SCF ( p < 0.004) and PPF ( p < 0.004), respectively. Conclusions All 4 commonly used insole materials were able to reduce pressure across the whole foot with PPF achieving significance. Off-loading the 1st MTPJ would still be best achieved with the commonly used plantar metatarsal pad of SCF with the aperture cut-out design.

Compartment syndrome of the leg after treatment of a femoral fracture with an early sitting spica cast. A report of two cases.

Compartment syndrome results from elevated tissue pressure within an osseofascial compartment that is caused either by an increase in the contents of the compartment, such as that produced by an accumulation of blood or other fluids, or by a decrease in the volume of the compartment, such as that occurring after the application of a constrictive cast or dressing1,2. The pathophysiology of compartment syndrome is well defined: as compartment pressure rises above arteriolar pressure, capillary flow decreases while venous outflow is obstructed, thus impairing perfusion to compartment structures1. Permanent losses of neural and muscular function are the feared outcomes. Compartment syndromes occur most frequently after lower-extremity trauma, often after a high-energy injury. We report the cases of two children in whom compartment syndrome of the leg developed after a low-energy fracture of the femoral shaft was treated with an early sitting spica cast. The parents of both children were informed that data concerning their cases would be submitted for publication. Case 1. A twenty-month-old boy fell and sustained a spiral midshaft femoral fracture. The fracture was not angulated, the limb was shortened by 1 cm, and the patient had normal circulation and neurologic function distal to the fracture. There were no signs of injury to the leg. A long-leg splint was applied in the emergency department and, four hours after the injury, a spica cast was applied in the operating room with the patient under general anesthesia. The casting technique, which was described by Czertak and Hennrikus3 in 1999 and is a modification of the technique described by Kasser4, involved three steps: (1) placement of a below-the-knee fiberglass cast on the affected leg (including the foot) with felt padding along the calf and the popliteal fossa, (2) application of a …

Instrumented izod impact testing

AbstractThe notched Izod impact test is the most prevalent technique used to characterize the effects of high‐impulse loads on polymeric materials. In order to extract ancillary information concerning fracture properties in addition to the total fracture energy, an instrumented version of this test is examined. Oscillations in the load signal, which severely degraded the utility of the data for materials fracturing in a brittle manner, are determined to be the result of specimen vibration caused by the impact of the hammer. Placement of a felt cushion on the face of the hammer is shown to eliminate these oscillations and the effects of the felt on the load‐time information are shown to be minimal. Finally, peak load data extracted from instrumented Izod tests employing felt padding, is used to determine the stress‐intensity factor for several plastics of commercial interest. © 1993 John Wiley &amp; Sons, Inc.

Radiography of the Optic Foramina Employing the Bullitt Mastoid Apparatus

The Bullitt apparatus for mastoid radiography, which provides a fixed angle of projection, can readily be utilized for obtaining radiograms of the optic foramina. This is made possible by placing the head so that the central ray traverses the contralateral asterion and emerges through the opposite optic foramen, projecting it as a circular shadow (Fig. 1). With the patient supine and the occiput resting on the elevator of the Bullitt apparatus, the head is rotated until the external canthus of the eye is in contact with the cross mark on the celluloid window. The nose is then pressed firmly against the felt padding. If the nose does not reach the padding, it should be placed lightly against the celluloid window. The head should be neither flexed nor extended while being rotated into position (Figs. 2 and 3). An 8 × 10 inch cassette, previously marked “right” and “left,” is placed in its holder and the tube positioned as for mastoid radiography. Both exposures are made on the same film. With children it is necessary to elevate the head so that the external canthus of the eye reaches the cross mark. It may also be occasionally necessary to vary the position of the external canthus of the eye in patients with long or short anteroposterior skull diameters. These patients' heads should be placed so that the external canthus is two or three millimeters above or below the cross mark. Comment A satisfactory film should show both orbital crests on the same level, indicating identical projections. The optic foramina are seen as circular shadows within the orbits. With practice it is possible to obtain comparable radiograms without undue difficulty.

A PORTABLE AIR SAMPLING APPARATUS FOR THE COLLECTION OF LARGE VOLUMES

T HE apparatus here described has been designed for the rapid collection in duplicate of relatively large volumes of air to be examined in the laboratory for such gases as carbon monoxide, hydrogen sulphide, oxides of nitrogen, etc. Minute amounts of these gases are of hygienic significance and the standard methods of analysis require the aspiration of large quantities of such air through appropriate absorbents. It is not practicable as a rule to make the analysis on the spot, particularly if the air is rapidly changing in composition, owing to the time required for aspiration and the special apparatus necessary to complete the analysis. A situation might arise, for example, in a sewer, in an engine-room or after gunfire in a turret aboard ship when it is imperative to take large samples speedily, so that a representative portion within a short-time interval may be obtained. The advantages of col^ lection in duplicate are obvious. The present apparatus is designed to fulfil such requirements. The apparatus is portable, protected against breakage under shipment, and air-tight. It consists of a wooden case 17 inches long, 12 inches deep and 141 inches high, enclosing two glass bottles each of 2,000 cc. capacity, with gas-tight glass stopcocks, and fitted with a standard thermometer. The bottles are connected by glass and metal tubes with theinlet of a brass suction pump of special design. The writer has determined on the basis of a large number of tests that each stroke of the suction pump draws about 800 cc. of air through the two bottles at the rate of about 1 stroke per second. This was observed by connecting the two lower stopcocks to a gas holder and exhausting a definite quantity of air from the latter through the bottles with the pump. The course of the air in sampling is as follows: Through stopcocks e 1 to bottles, through stopcocks e 2 to the reducing T-tube g to h and to pump. The bottlers rest on felt pads and are held firmly in place by copper straps encased in felt. The rubber stoppers are carefully wired in place. The pump is readily accessible for interior inspection. There is an outside carrying case provided for shipment not shown in 'the sketch. This has a protective arrangement of springs at the bottom and also on the under side of the cover; the sides, cover and bottom are covered with very heavy felt padding. The inside case is therefore guarded against sudden jar in handling and no further packing material is needed. Thorough tests for tightness were made. There may of course be marked changes in pressure of the contained sample as a result of temperature variations; thus, a drop from 70 F. to 32 F. would entail a fall