Example of entry

Name: Hapla 3D System 

Indications

Applied in cases where a plantar foot ulcer is present and pressure redistribution is required. The pad is desirable for patients who wish to have continued mobility and where patient compliance is key. 

Background

It is estimated that 15% of people with diabetes will develop a foot ulcer in their lifetime (Edmonds, Blundell, Morris, Thomas, Cotton and Watkins, 1986). The development of foot ulceration is multi-factorial, however there are several well established pathways. Trauma caused by elevated pressure areas under the foot, when in combination with sensory neuropathy, is a key factor in both the development and delayed healing of neuropathic diabetic foot ulcers (Armstrong, Lavery and Harkless, 1998). Efforts at managing plantar ulcerations have been directed mainly at the reduction of plantar pressures (Raspovic et al, 2000). Clinically, a variety of methods are used to redistribute pressure away from an area of ulceration. These have included felt padding (Birke et al, 2003; Pendsey et al, 2003). 

Function

Pressure redistribution/reduction away from plantar ulcer site. 

Materials used

  • 10mm Hapla all wool felt semi compressed
  • 5cm Chirofix retention tape       

Parameters of padding

 


1st layer – Valgus  filler (to level foot surface)     

Distal

-

Proximal to weight bearing surface of 1st and 2nd metatarsals

Proximal

-

Just distal to the weight bearing surface of the calcaneum

Medial

-

Follows the curve of the medial arch

Lateral

-

In line with the 2nd/3rd metatarsal space running from the distal position of the weight bearing surface of the calcaneum for a position proximal to the 2nd/3rd metatarsal


2nd layer

Distal

-

Distal borders of the metatarsal heads and approximately 10mm below web space

Proximal

-

Proximal to the weight bearing surface of the calcaneum

Medial

-

Follows the line of the 1st metatarsal shaft to a point corresponding to the distal edge of the calcaneum

Lateral

-

Follows the line of the 5th metatarsal shaft to the distal edge of the calcaneum

Application

- Aperture is cut in the appropriate place before application

3rd layer – Plantar Slab, Distal & Proximal as above 

Medial

-

Follows the line of the 2nd pad but 10mm wider

Lateral

-

Follows the line of the 2nd pad but 10mm wider, aperture is cut in the appropriate place slightly wider than that on pad two

Bevel

-

All pads are 45º regular bevelled and then piecrust bevelled. Aperture is cut in 2nd and 3rd pads with reverse 45º bevelled and the piecrust bevelled also

Application

-

Care should be taken that the padding/aperture borders do not encroach on the wound site

Strappings

-

Occlusive strapping is applied using 5cm Chirofix transverse strapping on each of the three layers. Finally the aperture is lined with the strips of Chirofix


Advantages to practitioner 

  1. Technique can be implemented immediately
  2. Increased compliance as it is obvious if it has been removed
  3. Cost-effective, compared to other off loading techniques
  4. Pressure is redistributed 24/7
  5. Primary dressing can be changed in the aperture by any health professional without removing the padding 

Advantages to patient 

  1. Padding is comfortable to the patient
  2. Helps to maintain patient mobility 

Material cost

  • 10mm Hapla felt approx 1 sheet £6.50
  • 5cm x 1m Chirofix £0.25
  • Total approx cost £6.75 

Time to prepare 

Chair-side in 25 minutes 

Effectiveness

Electronic readout without padding   Electronic readout after padding

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