padding materials

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padding materials

clinical materials used specifically to cushion, deflect pressure from or protect an area, substitute for lost tissue; adhesive padding materials include felts, polyurethane and polyethylene sheet foam and fleecy web that are shaped and stuck directly to skin, added to insoles or added to the shoe inner (see individually named pads Table 1 and Table 2 and Box 1)
Table 1: Examples of clinical pads
Pad typeExamplesDescription
Digital padsPlantar bar/long propSCF pad formed to infill the plantar aspect of the shanks of lesser toes, in order to prevent/reduce overcontraction of one or more lesser toes
Dorsal barSCF pad formed to infill the dorsal aspects of one or more hammered or retracted lesser toes, to reduce trauma to the skin overlying the prominent interphalangeal joints
Dorsoplantar splintSCF pad made as a combination of the plantar and dorsal bars, to correct digital deformity/reduce trauma to the apices and dorsa of lesser toes
Interdigital wedgeSCF or foam (plain, cavitied or holed) pad formed to match the dimensions of the interdigital space to reduce reformation of an interdigital heloma molle
Dorsal proximal/distal/apical/interdigital crescentA crescent-shaped pad applied proximal/distal to the dorsal/apical/interdigital area of a hyperkeratotic lesion on a digit, to reduce local pressure and friction
Dorsal horseshoeA horseshoe-shaped pad, where the 'arms' of the horseshoe cover the dorsal aspects of toes adjacent to the digit affected by a corn, and the U acts in the same manner as a crescent pad to protect the lesion
Plantar metatarsal padsPlantar coverA pad that covers the plantar skin of the forefoot, from the webbing to a line approximately 1cm distal to the bases of the metatarsals
U'd plantar coverA plantar cover into which a U has been cut to deflect pressure away from a plantar lesion. The U may be infilled with cushioning material
Winged plantar coverA plantar cover into which semicircular cutouts have been made, to deflect pressure from the 1 and/or 5 MTPJs
Plantar metatarsal padA pad applied to the 2/3/4 metatarsals, the distal limit of which applies pressure to the 2/3/4 metatarsal heads so that the 2/3/4 MTPJs are extended and the 2/3/4 toes realigned into a more functional position; the pad will also reduce compression between adjacent metatarsal heads
Plantar barA pad similar to a plantar cover, the distal limit of which had been shaped to accommodate up to 5 U'd areas
Shaft pad/long shaft padA pad applied to an individual metatarsal to allow sagittal-plane realignment
OthersD filler
Valgus pad
A pad that is shaped to infill the plantar aspect of the medial longitudinal arch to reduce excessive pronation or ease the pain of foot strain
Hallux valgus ovalAn oval pad, with or without a central cavity or hole, that is applied to the medial aspect of the 1 MTPJ to reduce local shear stresses in cases of HAV
Heel padA pad shaped to the plantar aspect of the heel, to cushion or reduce pressure to a plantar bursitis or heel spur
Posterior heel padA pad designed to deflect pressure from the posterior lateral area of the heel, in cases with Haglund's deformity
Doughnut pad
Ring pad
Oval pad
A circular pad with a central cavity or hole applied to the plantar aspect of the heel to protect the point of insertion of the plantar fascia
Cobra padA pad that combines a medial heel wedge, a valgus filler and a medial forefoot pad, to reduce excess foot pronation
Dumbbell padA pad that combines the action of a shaft pad to dorsiflex an individual metatarsal head, and an interdigital wedge, to reduce friction and pressure at the depth of the interdigital sulcus
Achilles tendon padA pad applied to the posterior aspect of the heel, to reduce pressure and friction at the insertion of the tendo Achilles

SCF, semicompressed felt; MTPJ, metatarsophalangeal joint; HAV, hallux abductovalgus.

Table 2: Functions of clinical padding materials
Compressed feltTo apply moderate leverage to a segment of a foot, such as a forefoot or rearfoot wedge
Semicompressed feltTo protect vulnerable tissues and reduce the rate of reformation of hyperkeratotic lesions, such as after the enucleation of corns, by cutting a U, a wing, a cavity or a hole in the padding material to correspond to the site of the lesion
To reduce compression on soft tissues imposed e.g. by ground reaction forces and underlying bony prominences
To substitute for lost or atrophic tissues, e.g. overlying a bony prominence
To carry a medicament, e.g. where salicylic acid paste is applied to a lesion by locating the medicament in a cavity within the semicompressed felt pad
Felt and foamTo combine the benefits of both semicompressed felt and polyethylene foam in one material
Polyurethane foamsTo cushion an area lightly
To infill a cavity, wing or U in a semicompressed felt pad
Polyethylene foamsTo provide a degree of cushioning, e.g. where soft tissues have undergone atrophy
To infill a cavity, wing or U in a semicompressed felt pad
Fleece/fleecy webTo aid retention of a small sterile gauze dressing
To reduce friction at the skin surface, after local callosity has been debrided
To reduce shear stress in areas of tissue subject to bursa formation
Box 1: Principles of clinical digital padding
  • The full thickness of a dorsal digital pad should not extend proximally beyond the base of the proximal phalanges

  • The full thickness of a dorsal digital pad should not extend distally beyond the proximal interphalangeal joints (unless the pad is specifically designed to protect a more distal dorsal lesion)

  • The distal edge of a plantar pad should conform to the distal edge of the plantar fatty pad of the foot (the plantar webbing)

  • The full thickness of the padding material should fit proximally to the pulps of the toes

  • The padding material must be thick enough to give adequate protection from dorsal, plantar and interdigital forces and maintain digital correction

  • The medial and lateral edges of the full thickness of digital pads should not encroach onto adjacent toes, when the foot is within the shoe

  • The bevel at the medial and lateral borders of a digital pad should extend onto the interdigital facets of the most medial/lateral padded toes

  • Footwear must be of sufficient size to accommodate both the correction/increase in length of the toes achieved by the pad and the bulk of the pad, without constriction

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