what-when-how
In Depth Tutorials and Information
figure 8.2
Increased RA foot deformity requiring specialist footwear
reduce the forces that cause callus. Callus formation is known to be the
precursor to ulceration in this patient group and therefore it is important
that the forces that cause this be reduced. These forces can be direct,
shear or tensile, or a combination of two or more. All lead to inflammation
in the tissues, excess callus formation, tissue damage and ulceration.
Examples of the forces include:
•
One episode of high pressure causing direct trauma to the tissues,
for example standing on a nail.
•
Intermittent pressure caused by walking (and increased with
mechanical influence from, for example, leg length difference causing
increased pressure on the medial aspect of the longer leg if it is
pronating as compensation -
Figure 8.6
).
•
Continuous pressure caused by tight footwear; even low forces may
prevent circulation of blood to the tissues, causing ischaemic
changes.
