Supplementum 3+4/2007 - SpoleÄnost pro pojivovÃ© tkÃ¡nÄ›

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ez zohlednění abnormální biomechaniky nohy při chůzi. Někdy je konstrukce obuvi zcela špatná, poškozuje nohu pacienta. Dochází ke zmaření předchozí dlouhotrvající a nákladné zdravotní péče. (obr. 7, 8) Na optimálním protetickém zajištění komplikovaných pacientů tedy z velké části závisí jejich další osud. Proto je třeba věnovat i výběru protetického pracoviště, které zajistí obuv po zhojení diabetické ulcerace, mimořádnou pozornost. Závěr Pro úspěch a zhojení diabetických defektů chodidel je důležitá týmová spolupráce jednotlivých odborníků se zaměřením na lokální ošetření defektů moderními postupy léčby, adekvátní výběr vhodné ortotické pomůcky dostatečně odlehčující a stabilizující daný segment .Po zhojení defektu je důležitá prevence opakovaného postižení pacienta zajištěním vhodné ortopedické obuvi a důsledná edukace pacienta. Neméně důležité je zajištění permanentní edukace zdravotnických pracovníků týkající se prevence vzniku a léčby diabetických defektů. ORTHOTIC SUPPORT IN INTERDISCIPLINARY TREATMENT OF DIABETIC FOOT Krawczyk P., M.D. 1 , Zahumenský E., M.D. 2 Fig. 8. Nevyhovující individuálně zhotovená obuv. Zcela nevyhovující konstrukce obuvi. Unsatisfactory individual footwear. Entirely improper shoe construction Introduction Around 5,000 amputations are performed every year in the Czech Republic due to diabetes complications. Early detection of increased plantar foot pressure and correct relieving of these threatened parts can 386 The 9 th Prague-Sydney-Lublin Symposium
significantly reduce the risk of defects of the sole of the foot. Treatment of already developed defects requires cooperation between the physician, the podiatrist and the orthotic technician. The authors describe their experience of interdisciplinary cooperation during detection and treatment of sole defects. The localization of ulceration (in the front, middle and rear part of the foot), the extent of the affliction, the healing stage and the overall condition of the patient are the crucial factors for the selection of specific pressure relief aid. Orthotic and footwear management In case of entirely external non-infected neuropathic ulcerations local self-adhesive relief aids are used which are applied in the wound surroundings and reduce the pressure on the area. Timely application of these is crucial. It is desirable that they are available to the front-line doctor (GP, diabetologist) or possibly even to the educated high risk patient. Similarly, this holds for post-operative shoes for relieving the front or rear part of the foot (fig. 1). Their primary advantages are the low price and the possibility of immediate use and that is why this means of relief is among the most often used. However, it is necessary to check that the ulceration is indeed outside the weight-bearing regions of the sole. Otherwise, usage of an individually-manufactured shoe or of a different type of relief is to be considered. Combination with crutches or a wheelchair is eligible. The patient should be educated about the necessary change in the way of ambulation and the significant reduction of foot stress. The shoes are only meant for the most basic life activities. Older patients suffering from vertigo and stability disorders often refuse to use the pressure relieving shoes or splint because of the risk of fall and their defects are not healing properly. In such cases a pressure relief insole is applied, with hole in the area of the defect or high-risk bone prominence which reduces the direct local pressure on the affected regions. To reduce the deteriorative shear forces the edge of the hole is filled with soft compressible substance. An insufficiently compressible material may, however, increase the local pressure. This means requires shoes with sufficient inner space – deep medical shoes have proven eligible (fig. 2), meeting the requirements for convenient shoes for diabetic patients. Contact plaster fixation, especially non- -removable, is being the gold standard, though in routine operations it is an elaborate and expensive method which demands erudition, experience and enough room in the surgery. Therefore, if application of the pressure relief shoes is not sufficient, the removable orthoses are used for relieving the front part of the sole (fig. 3), various types of AFO orthoses for relieving the pressure on the heel or Walker, VACOPED or VACOdiabetic splints. Pneumatic Aircast brace was also tested and has appeared very prospectively. Patients with severe deformity, defect in the middle part or in the medial area of the sole, osteomyelitis, in the acute stage of Charcot’s neuroarthropathy or defects of the post-amputation stumps have shown very good results when modified Algover orthosis with embedded stirrup for complete relief of the sole was applied. (fig. 4) ambul_centrum@volny.cz 387
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Pokroky ve výzkumu, diagnostice a
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Society for Connective Tissue & Cze
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RECESS 12.00 - 13.00 P.M. Chairmen:
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JELEN K., KOUDELKA T., TĚTKOVÁ Z.
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Figure 2. Preoperative lateral view
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and studied for the angle of kyphos
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Since 28 years we introduced new ea
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etiopathological (epg) classificati
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Figure 1 “S“ scoliosis 1 st epg
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Figure 2a “C“ scoliosis II / A
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Figure 3 “Border-line scoliosis
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BMD [g/cm 2 ] 1,29 1,21 1,13 1,04 0
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Including Head: Z = -1.7 Excluding
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From the laboratory parameters we a
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ické vyšetření nerozliší úby
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Obr. 1c kých ukazatelů kostního
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šení osteoresorbce s mírným def
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OSTEOGENESIS IMPERFECTA FROM THE PO
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nutrition. We were also trying to f
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Key words: osteogenesis imperfecta,
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CASE REPORT PACHYDERMOPERIOSTÓZA S
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Obr. 2a. Snímek pravého kolenníh
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Page 47 and 48: Osteochondrózy obvykle postihují
Page 49 and 50: Obr. 1b: RTG kyčlí v AP projekci
Page 51 and 52: Fig. 1. The bone remodeling process
Page 53 and 54: covery, Journal of Musculoskel Neur
Page 55 and 56: Fig. 3. Definition of coordinate sy
Page 57 and 58: subsystémy trupu „viscerálního
Page 59 and 60: dral bone. The tangential kinetic e
Page 61 and 62: REVIEW ARTICLE KORZETOTERAPIE PRO D
Page 63 and 64: Obr. 3 Obr. 4 ambul_centrum@volny.c
Page 65 and 66: Figure 1. Schema of brace parts con
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Page 69 and 70: Fig. 1 - Angle of vertebral rotatio
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Page 73 and 74: Obr. 1a, b. RTG snímek rukou v AP
Page 75 and 76: Abstract Poranění lebky a dále m
Page 77 and 78: Fraktura lebky (s mozkem) při pád
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Page 81 and 82: Obr. 1 Závislost zatlačení na č
Page 83 and 84: Použitím visko-plastického model
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Page 87 and 88: Plochá noha Typ F Přední anti-pr
Page 89 and 90: Korekce paty C, C+, C- Anti-valgus
Page 91 and 92: Slim elegance sytém Korekce ambul_
Page 93 and 94: ace u daného pacienta skutečně m
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Page 103 and 104: Literatura 1. ANDERSON M, GREEN W T
Page 105 and 106: Stabilometrie je neinvazivní metod
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Page 109 and 110: Discussion These data suggest that
Page 111 and 112: tou a koordinací pohybu, a tedy so
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Page 115 and 116: PLACENÁ INZERCE ● PAID ADVERTISE
Page 118: Osteologic Academy Zlin, MEDIEKOS L
Page 123 and 124: TECHNICKÁ ORTOPEDIE OSTRAVA - PROT
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Supplementum 3+4/2007 - SpoleÄnost pro pojivovÃ© tkÃ¡nÄ›

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