281218 - ..
281219 - [On 170605 1547 letter to Doctor Tang notifies new wound
281220 - discovered today on 170531, worsened, and so will pause
281221 - hiking until wound heals. ref SDS 30 B672
281223 - ..
281224 - [On 170608 1156 meeting with Doctor Tang in Podiatry VAMCSF
281225 - advised wound right foot long toe made significant recovery
281226 - treated with Hydrofera Blue Bacterostatic dressing, and
281227 - came within milimeters of requiring amputation, ref SDS 31
281228 - 4G5J
281230 - ..
281231 - [On 170810 reported in case study on 160101 0700 right foot
281232 - long toe abrasion recurrence; treat again with Hydrofera
281233 - Blue Bacteriostatic dressing. ref SDS 3 TQPT
281234 -
281236 - ..
281237 - This may indicate significant hiking since 170527, and/or increased
281238 - taping, and possibly too tight on the toe. The application is very
281239 - awkward for the patient, and so causes defective work, if done alone,
281240 - and even with a skilled provider.
281241 -
281243 - ..
281244 - Work Plan Rest Toes Without Plantarflexion Care Until Friday 170602
281245 -
281246 - Today, decided to allow feet to rest without taping. Will review
281247 - again during meeting with Arlene on Friday, 170602 1000, which was
281248 - scheduled last Thursday on 170525 0730. ref SDS 26 869H
281249 -
281251 - ..
281252 - Innovation Try Coban Tape Less Aggressive Enable Skin Breath
281253 -
281254 - May be able to wrap long toe with Coban tape to prevent pronation, and
281255 - use Rocktape horizontally to secure Coban tape which would otherwise
281256 - come loose from dynamics of hiking and running. Coban might be easier
281257 - for the patient to replace each day since it does not significantly
281258 - stick to the skin, but only to itself. This taping scheme could be
281259 - removed daily when not actually hiking, in order for the toe to avoid
281260 - the level blistering injury found today, per above. ref SDS 0 4G5J
281262 - ..
281263 - Might be possible to avoid completely wrapping the toe, and thereby
281264 - provide some breathing that prevents blistering.
281266 - ..
281267 - Moreover, with modifications to orthotic inserts being tried today,
281268 - per below, ref SDS 0 0M6M, less aggressive plantarflexion taping may
281269 - work even better.
281270 -
281271 -
281273 - ..
281274 - Blister Blood Severe Left Foot Side Big Toe No Care Allow Heal Naturally
281275 -
281276 - Doctor Tang examined blood blister on left foot inside of big toe...
281277 -
281278 - 
281280 - ..
281281 - The doctor advised the best care is to avoid treatment at this stage
281282 - and simply continue to protect the area when hiking that causes
281283 - severe pressure on the wound.
281284 -
281285 -
281286 -
281288 - ..
281289 - Modify Orthotic Insert Relieve Pressure Right Foot Plantar Plate
281290 - Plantar Plate Right Foot Modify Orthotic Insert Relieve Pressure
281291 -
281292 - Doctor Tang modified orthotic insert for right shoe only today, in
281293 - order to experiment for a configuration that relieves pressure on
281294 - plantar plate.
281296 - ..
281297 - He first marked the location of the plantar plate on the bottom of the
281298 - foot. Then pressed the existing orthotic insert against the foot to
281299 - transfer the plantar plate location to relative position on the
281300 - insert. He added felt pad to the forefoot area, but cut a hole in the
281301 - pad, and placed soft, plyable plastic into the hole with the aim of
281302 - reducing pressure on the plantar plate as the ball of the foot strikes
281303 - the ground when hiking and running. Standard tape was placed to hold
281304 - the soft plastic in place. The doctor finally added another felt
281305 - member to elevate and support the arch of the foot, with intent to
281306 - further reduce pressure of the plantar plate, and distribute the load
281307 - to adjacent members of the foot, all as indicated in photograph...
281308 -
281309 - 
281311 - ..
281312 - Will try a hike today or tomorrow and notify him on Friday, 170602,
281313 - when onsite for plantarflexion taping by Arlene in Primary Care.
281314 -
281315 - [On 170605 1547 letter notifies material hardened that was
281316 - initially used when orthotic inserts were modified on
281317 - 170531, to provide softer material beneath plantar plate.
281318 - ref SDS 29 B669
281320 - ..
281321 - Walking around the hospital seemed to indicate improvement, i.e., no
281322 - noticable pain for planar plate tear injury.
281324 - ..
281325 - If this seems to relieve pressure/pain right foot plantar plate, then
281326 - will modify left foot orthotic insert accordingly.
281328 - ..
281329 - Tomorrow will try replacing Rocktape with Coban for less aggressive
281330 - plantarflexion taping scheme, per above. ref SDS 0 8Y7H
281331 -
281332 -
281333 -
281334 -
281335 -
281336 -
281337 -
281338 -
281339 -
2814 -