BY SALLY LAXTON BAppSci(Pod) PODIATRIST ... - Vasyli Medical

EDP- A case study for Vasyli medical trialling diabetic insole and Dr Comfort
footwear
BY SALLY LAXTON BAppSci(Pod)
PODIATRIST- Knox Community Health Service
EDP is a 68 year old female – solid build
Medical Hx
• Type 2 diabetes- on insulin
• Diabetic retinopathy
• Coronary artery disease
• Hypertension
• Hypercholesterolemia
• L 1 st bunionectomy June 06
Previous history of ulcers on feet which were alleviated by introduction of Propet
stretch shoes
Presented to clinic Sept 06 post L bunion surgery with ulcer under callus. With
consultation with the client the decision was made to treat conservatively as Eclient
wanted to avoid surgery due to post op infection in bunion. L 2 nd metatarsal head
dropped post surgery. Orthotist had made insole which was thick and heavy and
did not relieve pressure off 2 nd met head. (EVA with high Met dome and silicone
cover.)
Almost healed site many times with 10mm apertured felt padding but each time the
padding is reduced the site breaks down again.
Latest treatment.
15/5/08- Presented to clinic with a very sore foot
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4 photos
Presenting problem
15/5/08
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Post debridement- I love my job
Re applied 10mm padding and reviewed in 1 week
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One week later!!!!
22/5/08
From this the wound continued to improve with weekly debridement of very
thick, sometimes macerated callus and 10mm felt apertured padding, but the
site never completely healed. Site always dressed with vacutex and allevyn
dressings. Propet shoes had stretched and become quite floppy- purchased
instride stretch shoes but client felt they were not as comfortable
- 4 -

3/3/09
Central small fissure had opened further. Clinic notes were
LN 5516 R 2nd toe improving RDNS dressing with bactigras and melolin.
Dressing applied. L 2nd pl MPJ central area of ulcer larger, with cental shiny
hypergran tissue in centre of wound. Debrided and dressed with iodosorb and
vacutex and allevyn. Usual padding applied. R/v 7 days.
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10/3/09
LN 5529 L foot plantar ulcer not as deep with central granulating site. Padded
as previously. Dressed with Betadine, vacutex and allevyn. Gave Evelyn new
Vasyli diabetic orthotics. She said they felt very comfortable. R/v 7 days
17/3/09
S- Ulcer review and management.
O- L plantar ulcer sub 3rd MPJ, associated callus and slight maceration from
last visit. Granulating base. Ulcer R 3rd apex, base epithelialising. Exudate
+++
P- Dressed R 2nd with bactigras and melolin. Dressed plantar wound with
curasorb and vacutex. Applied plantar pad with cut out minus arch support.
Secured with hypafix. Cut nails.
24/3/09
S- Patient states that L arch area is sore and has been red and hot. She
describes the pain as a dull ache along with intermittent sharp stabbing pains
which is present also at night.
O- Wound L/F plantar aspect of 3rd MTPJ with surrounding maceration and
callus. Area of hypergranulation tissue that is also macerated which has
protruded through opening of wound. Wound margin decreasing. Wound R/F
apex of 2nd digit with associated callus which is epithelising.
P- Debrided callus. Made plantar cover with cut out and dressed wound firstly
with bactigras and allevyn. Upon second visit d-filler was added and aqualcel
AG and vacutex replaced bactigras.
E- R/v 1/52. Patient advised to apply cold pack to arch and to report on pain
levels at next visit as there is a suspicion of a charcot deformity.
31/3/09
S- Client had xrays taken of L foot, results coming in afternoon. Client not
feeling as much pain.
O&A- Bloody strike through on dressing, plantar L wound with minimal
maceration compared to previous appointment and hypergranulation tissue is
reducing in size. Small amount of surrounding HK. Took photo of wound,
client consents to photos and also photos to be sent to matt from vasyli.
Debrided surrounding HK. Applied plantar pad with cut out, d filler and met
dome. Dressed wound with aquacel Ag and alleyvn, which client says district
nurse applied 2 layers on previous dressing change.
Secured with hypafix.
7/4/09
S- Client has x-rays. Dressing fell off night before.
O&A- Xrays reveal L 2nd met has subluxed with no apparent met head, just
shaft and a large calcaneal heel spur. L 2nd MTPJ wound less macerated and
less callus build up. Minimal fluid present in wound. Applied plantar felt pads,
Debrided callus, dressed with aquacel Ag and Allevyn. Debrided callus of R
- 6 -

3rd apex. Debride callus on apex of R 1st, 2nd and 3rd and minimal callus
plantar 5th MTPJ. Dressed apex with bactigras and melonin. RDNS to do
dressing next Tues due to clinician holidays
7/4/09
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Orthotics after 1 month
- 8 -

21/4/09
S- Client has not been seen for 2 weeks over easter period and RDNS has
been treating wound. Last dressing change revealed purulent exudate, client
advised to see dr to get ABs. Client taking antibiotics still.
O&A-L Plantar 2nd MTPJ wound with less maceration and less HK build up.
Applied plantar felt pads, Debrided callus, dressed with aquacel Ag and
Allevyn. Debrided callus of R 3rd apex. Debride callus on plantar heel B/F.
Dressed apex with bactigras and melonin. Applied betadine to L arch area as
there are signs of tinea. Fitted client for vasyli shoes, size 10.5. Order form to
be submitted to vasyli and client to pay when shoes arrive. Client interested in
buying 2 pair.
28/4/09
O&A- No strike through on dressing. No maceration present. Less
surrounding HK. Photo taken of wound. Wound decreasing in size. Tinea
infection in L arch area better. Debrided surrounding HK. Applied felt met
dome/plantar cover with cut out and d filler. Applied betadine to tinea
infection. Dressed wound with aquacel Ag and melolin as wound does not
require extra absorption from alleyvn. Client still interested in purchase 2 pairs
on vasyli footwear.
- 9 -

8/5/09
Delivered and fitted new Vasyli shoes. Annie 10W and Betty 10.5W. R/v 9
days
18/5/09
R 2nd apical callus reduced. L 2nd pl MPJ callus reduced. Small central area
of callus in the fissure debrided. Eulactol cream applied. 10mm felt apertured
pad applied with 7mm D filler and met dome. R/v 7 days Client is very happy
with Dr Comfort shoes. Adv to wear all the time esp around the house instead
of slippers. Client happy to comply. Client now being seen every 2 weeks
instead of weekly
2/6/09
L pl callus reduced. Continues to improve becoming more like a corn and
callus- some concern that 3rd met head is now prominent!! - to be monitored.
7mm felt apertured pl cover with 10mm met dome and D filler. R/v 2 weeks
- 10 -

16/6/09
Client : c/o no pain or discomfort. Very happy with footwear which is holding
its shape well. Previous footwear deformed quite quickly. Caught a bus to the
local shopping centre and walked a considerable distance. Client very happy
to be returning to a more normal lifestyle
Orthotics after 3 months
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- 12 -

- 13 -

Another set of new orthotics have been issued to the client so she can have
them in a couple of pairs of shoes.
Clinician concerns- 3 rd met area with an increase in pressure but interesting to
see if the Vasyli Insoles reduce the sheer force so site doesn’t breakdown
Findings:
There was a marked decrease in the amount of callus and maceration
produced on wound site after the introduction of the Vasyli Diabetic orthotics
complimented by the wearing of the Dr Comfort footwear
Future:
• Clinician will gradually reduce the amount of padding over next 2
months.
• Increase time between visits.
• Client interested in purchasing some Dr Comfort runners as well
• Need to purchase new insole every 4-6 months?
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