CONTACTS
SUBJECTS
Right Foot Long Toe Severe Edema Within 2 MM Amputation Recover Hydr
3203 -
3203 - ..
3204 - Summary/Objective
3205 -
320501 - Follow up ref SDS 39 0000. ref SDS 37 0000.
320502 -
320503 -
320504 -
320505 -
320507 - ..
3206 -
3207 - Background
3208 -
320801 - On 170417 1330 met with Doctor Thuillier in Orthopedics, where he made
320802 - referral for Outpatient Physical Therapy to wrap plantar plate tear
320803 - with plantarflexion taping system. ref SDS 15 5T7K
320805 - ..
320806 - On 17425 0830 met with Sharlene in Physical Therapy. ref SDS 19 4G5J
320807 - Submitted Rocktape. Did exercises to evaluate flexibility. Sharlene
320808 - prescribed daily calf stretching exercises to strengthen plantar
320809 - plates toward preventing further injury. ref SDS 19 GY5J Sharlene
320810 - applied Rocktape to protect the right foot plantar plate tear using
320811 - alternate wrapping method. ref SDS 19 TW5J Did not tape left foot.
320812 - ref SDS 19 PQ4L Did 2 mile hike with good results, reflecting
320813 - Rocktape applied to right foot, and earlier in the morning taking
320814 - Naproxen. ref SDS 19 SY6N Returned home and reported good results to
320815 - Sharlene. ref SDS 19 YN59 She feels Rocktape needs to be replaced
320816 - every three days, ref SDS 19 XQ79,
320818 - ..
320819 - On 170427 0830 Sharlene explained that physical therapy cannot provide
320820 - treatment to aid healing plantar plate tears, in addition to using
320821 - protective boot and plantarflexion taping; she feels jacuzzi whirl
320822 - pool type treatment will not be effective to recover from Plantar
320823 - Plate tear injuries. ref SDS 20 E48H Patient doing additional
320824 - stretching prescribed by Sharlene. Had best hike in over a year,
320825 - following taping with Rocktape by Sharlene. ref SDS 20 0E5N Sharlene
320826 - used taping scheme again, that Doctor Hewitson demonstrated on 170411.
320827 - 170427 0830, ref SDS 20 TW5J
320829 - ..
320830 - On 170512 0832 brief meeting with Doctor Tang saying he will do
320831 - plantarflexion taping on 170517 0830, and consider with Doctor
320832 - Hewitson new orthotic inserts to prevent plantar plate injuries.
320833 - ref SDS 26 4G5J
320835 - ..
320836 - On 170524 0837 letter to Doctor Tang in Podiatry requesting meeting to
320837 - consider new ideas for orthotic inserts that relieve pressure on
320838 - plantar plate wound. ref SDS 28 4G5J
320840 - ..
320841 - On 170530 1302 sent letter reminding Doctor Tang of meeting tomorrow
320842 - morning on 170531 0815 to consider new orthotic inserts that relieve
320843 - pressure on plantar plate injury. ref SDS 31 4G5J
320845 - ..
320846 - On 170524 0837 at 1400 received letter from Doctor Tang recommending
320847 - meeting in Podiatry on 170531. ref SDS 28 N14M
320849 - ..
320850 - On 170524 0837 at 1407 letter to Doctor Tang asks about sending
320851 - reminder for meeting on 170531. ref SDS 28 ME7L
320853 - ..
320854 - On 170524 0837 at 1453 received letter from Doctor Tang approving
320855 - letter to remind of meeting on 170531. ref SDS 28 6T6G
320857 - ..
320858 - On 170531 0830 Doctor Tang removed plantarflexion taping on both feet.
320859 - Found the right foot long toe severely blistered, red and near
320860 - bleeding with a few small bubbles. ref SDS 32 4G5J This reflected
320861 - more thorough taping done by Kathy on 170527 0952. ref SDS 30 WM5F
320862 - Left foot long toe shows only minor abrasions, reflecting less
320863 - aggresive plantarflexion taping done by Arlene during the meeting at
320864 - the VA on 170525 0730. ref SDS 29 JY9M Decided to allow feet to rest
320865 - without taping. Will review again next week. ref SDS 32 OK6F
320867 - ..
320868 - On 170531 0830 Doctor Tang modified orthotic insert for right shoe
320869 - only today, in order to experiment for a configuration that relieves
320870 - pressure on plantar plate. ref SDS 32 0M6M Will try a hike today or
320871 - tomorrow and notify him on Friday, 170602, when onsite for
320872 - plantarflexion taping by Arlene in Primary Care. ref SDS 32 NM7H
320874 - ..
320875 - On 170605 0347 letter notifies Doctor Tang requests meeting on 170607
320876 - to continue work on plantar plate tear. Initially, there was
320877 - lumpiness, but this has mostly resolved. The material you tried last
320878 - week directly beneath the plantar plate worked well, but eventually
320879 - hardened. Today, found some "gel" material that may provide soft,
320880 - resilient support for plantar plate section you cut out in the
320881 - orthotic insert. ref SDS 37 B669
320883 - ..
320884 - On 170605 0347 letter notifies Doctor Tang wound discovered on long
320885 - toe worsened. May have to layoff hiking entirely for a month to let
320886 - everything heal up. Applied Hydrofera Blue with gauze and Coban tape,
320887 - and wrapped big toe with gauze and Coban tape to prevent abrasion
320888 - rubbing against the dressing on the long toe, especially when shoes
320889 - press toes together. ref SDS 37 B672
320891 - ..
320892 - On 170606 0936 letter from Doctor Tang notifies cannot meet 170607.
320893 - Recommends discontinue plantarflexion taping on long toe until wound
320894 - heals, and to avoid risk of requiring amputation of the toe.
320895 - ref SDS 38 7U67 Proposes meeting next day on 170608 or on 170609
320896 - 1200. ref SDS 38 7U7T
320898 - ..
320899 - On 170606 0936 at 0938 letter to Doctor Tang agrees to meeting on
320900 - 170608 1200, and notified discontinued plantarflexion taping on
320901 - 170604, to let wound on long toe heal. ref SDS 38 EX9K There has been
320902 - no pain in plantar plate for over a week, and no swelling on ball of
320903 - foot at plantar plate location. Previously, swelling was pronounced
320904 - after hikes. ref SDS 38 WX5V
320906 - ..
320907 - On 170606 0936 at 0938 letter notifies Tang that Doctor Simpson in San
320908 - Francisco, and Doctor Lee in Sacramento will be pleased increased
320909 - hiking enabled by Podiatry care using plantarflexion treatment and
320910 - modified orthotic inserts which relieve pressure on plantar plate
320911 - injury (now paused again - see letter on 170605, that notified paused
320912 - hiking for a month in order for injuries to heal, ref SDS 37 B672, has
320913 - reduced blood pressure and heart rate, which increased since last
320914 - August as side effects of GI medications needed to resolve increased
320915 - ulceration LESV. Since ulceration has now resolved, Doctor Lee
320916 - reduced Pantoprazole beginning on 170616. Fascinating how Podiatry
320917 - influences coronary and digestion issues. ref SDS 38 WX59
320918 -
320919 -
320920 -
320921 -
320922 -
320923 -
320925 - ..
3210 -
3211 -
3212 - Progress
3213 -
321301 - Right Foot Long Toe Wound Significantly Improved Avoid Amputation
321302 -
321303 - Follow up ref SDS 40 4G5J. ref SDS 32 4G5J.
321304 -
321305 - Doctor Tang removed dressing applied earlier this morning, reported in
321306 - another record on 170608 0818. ref SDS 40 H14K The doctor noted the
321307 - wound appears much improved, with no glistening on the wound, and the
321308 - entire toe is significantly less inflammed and scaly, compared to
321309 - prior conditions after stopping hiking after 170604, shown by
321310 - pictures...
321318 - ..
321319 - The doctor advised this wound likely came within millimeters of
321320 - requiring toe amputation. He does 2 or 3 toe amputations a week, and
321321 - so is very familiar with conditions requiring amputation. Doctor Tang
321322 - further noted that toe wounds quickly cascade out of control, because
321323 - the skin is close to metatarsal bones, and so wounds quickly infect
321324 - these bones, if not treated in time to be effective.
321325 -
321326 - [On 170810 reported in case study on 160101 0700 right foot
321327 - long toe abrasion recurrence; treat again with Hydrofera
321328 - Blue Bacteriostatic dressing. ref SDS 4 TQPT
321330 - ..
321331 - So, if treatment with Hydrofera Blue Bacterostatic dressing applied to
321332 - the wound on Monday, reported in the letter to Wound Care on 170605
321333 - 1119, ref SDS 36 V84P, and later to Podiatry the same day, 170605
321334 - 1547, ref SDS 37 B672, was delayed to the next day on 170606, or until
321335 - today, then today, may have been another of Doctor Tang's 2 - 3
321336 - amputations for the week, per above. ref SDS 0 673M
321338 - ..
321339 - The doctor asked why wound occurred on right foot long toe after he
321340 - observed mere edema during care in Podiatry on 170531? ref SDS 32 4G5J
321341 -
321342 - On 170531, no treatment seemed needed, other than to avoid
321343 - Plantarflextion treatment with Rocktape. ref SDS 32 OK6F The
321344 - long toe was appropriately left without dressing.
321346 - ..
321347 - On 170601 wound right foot long toe seemed better, so
321348 - experimented for hiking by wrapping toe with lambs wool, and
321349 - used Coban tape for plantarflexion care, planned in the record
321350 - for the meeting with Doctor Tang on 170531 0830. ref SDS 32
321351 - VF3L After 7-mile hike, wound on long toe seemed about the
321352 - same, indicating favorable response to treatment. ref SDS 4
321353 - XURQ This was reported to Podiatry in a letter on 170601 1552.
321354 - ref SDS 33 4G5J
321356 - ..
321357 - On 170602 wound right foot long toe seems to have worsened
321358 - overnight, despite seeming better after hike yesterday on
321359 - 170601. ref SDS 4 213H Drove to Jacksonville, Oregon for mom's
321360 - memorial service, so no hiking and no dressing on long toe.
321361 - ref SDS 35 0O5I
321363 - ..
321364 - On 170603 wound right foot long toe still seems worse this
321365 - morning, despite not hiking yesterday. Drove to Albertson's
321366 - store on the other side of the freeway and bought healing agent
321367 - and bandaids. Applied agent with bandaid before going hiking,
321368 - and without plantarflexion taping with Rocktape. ref SDS 4 XVWQ
321369 - Did slow 4 mile hike, no evident pain. ref SDS 4 XVXR
321371 - ..
321372 - On 170604 wound right foot long toe seems worse again this
321373 - morning after returning from Central Point Oregon for mom's
321374 - memorial yesterday. Applied Hydrofera Blue dressing, and
321375 - applied Plantarflexion care with Rocktape over Hydrofera Blue
321376 - dressing to protect long toe wound. After hike pain on right
321377 - foot increased so removed plantarflexion taping, and found
321378 - wound much more worse than before the hike. ref SDS 4 XWTP
321380 - ..
321381 - It appears wound on right foot long toe worsened when hiking 4 miles
321382 - due to having minimal protection on 170603. After that even
321383 - significant protection failed to prevent wound from worsening when
321384 - hiking the next day on 170604.
321386 - ..
321387 - Doctor Tang dressed the wound using supplies on hand. He said to
321388 - change the dressing tomorrow. The doctor approved switching to
321389 - Hydrofera Blue Bacterostatic dressing reported in the letter to
321390 - Podiatry on 170605 1547, ref SDS 37 B672, noting this line of care
321391 - achieved significant recovery that avoided amputation. This will be
321392 - applied with...
321393 -
321394 - Curad
321395 - Silver Solution
321396 - Antimicrobial Silver Wound Gel
321397 -
321398 - https://www.walgreens.com/store/c/curad-silver-solution-first-aid-antimicrobial-gel/ID=prod6068617-product
321400 - ..
321401 - This treatment gel was purchased while in Oregon for mother's memorial
321402 - service reported in case study on 160101, for 170603. 160101 0700,
321403 - ref SDS 4 XVWQ Could this be similar to silver nitrate which Lana
321404 - applied with cotton swab to resolve undermining observed in the
321405 - hematoma wound on the left leg, reported on 151104 1130. ref SDS 2
321406 - 3Q8M
321408 - ..
321409 - Advised of learning about Hydrofera Blue Bacterostatic dressing from
321410 - Lana in Wound Care. She used it and Enluxtra and in combintation with
321411 - silver nitrate to heal major hematoma on left leg, and so avoided
321412 - reconstructive surgery, considered by Clara in the Surgery Department
321413 - on 151006 1315. ref SDS 1 LJ8N On 151215 1330, Doctor Stewart found
321414 - wound fully recovered without recourse to surgical reconstruction,
321415 - ref SDS 3 5X5L, similar to Doctor Tang determining surgical amputation
321416 - was avoided today.
321418 - ..
321419 - Asked about applying Plantarflexion care over dressing to protect the
321420 - wound from getting worse again? We could use lambs wool, Hydrofera
321421 - blue or Enluxtra dressing to insulate and protect the toe from further
321422 - injury when taped for hiking to prevent injury to the plantar plate.
321424 - ..
321425 - Doctor Tang feels the current wound needs to heal further before
321426 - trying to hike with plantarflexion care applied over insulating
321427 - medium.
321428 -
321429 -
321431 - ..
321432 - Modify Orthotic Insert Relieve Pressure Right Foot Plantar Plate
321433 - Plantar Plate Right Foot Modify Orthotic Insert Relieve Pressure
321434 -
321435 - Follow up ref SDS 32 0M6M.
321436 -
321437 - Doctor Tang considered the record hiking with modifications he made to
321438 - right foot orthotic insert on 170531 0830. ref SDS 32 0M6M Patient
321439 - history in case study dated 160101, reports hiking 7, 4 and 5 miles,
321440 - beginning the next day on 170601. ref SDS 4 Z94O Hiking experiment
321441 - had to stop on 170605, due to worsening of wound on right foot long
321442 - toe caused by taping for plantarflexion care, per above. ref SDS 0
321443 - 4G5J
321445 - ..
321446 - This case history is reported in the record on 160101, showing...
321447 -
321448 - On 170601 - hiked 7 miles. Start slow pace on Treat asphault
321449 - surface rehab right foot plantar plate tear pain level 0, and
321450 - testing revised orthotic insert right shoe. Time 1.25 miles 19
321451 - minutes. On Clayton concrete sidewalk right shoe with added
321452 - felt padding on orthotic insert began feeling lumpy. Did not
321453 - feel plantar plate pain. About mile 2.8 began feeling stress,
321454 - similar to "burning sensation" across ball of foot, but no
321455 - plantar plate pain. Turned corner onto Ygnacio Valley Road
321456 - with asphault surface. About mile 4.0 "burning sensation"
321457 - ended. Seemed like plantar plate tear right foot pain level 2.
321458 - About mile 4.0 plantar plate pain level 0. At mile 5.5 turned
321459 - corner on Cowell to do half lap for first test of experiment
321460 - with modified orthotic insert right foot. ref SDS 4 XUSX
321462 - ..
321463 - Letter to Doctor Tang on 170601, reported: The feel was lumpy.
321464 - At places along 7 mile route, pressed big toe down to stabilize
321465 - pressures. Could a thinner felt pad be tried, and with softer
321466 - material for the hole you cut to protect the Plantar Plate?
321467 - ref SDS 33 SL8U
321469 - ..
321470 - On 170603 - hiking did 4 miles going very slow with Kathy in
321471 - Oregon from hotel in Central Point went East on Biddle Road for
321472 - 2 miles, then walked back. Right foot planta plate injury held
321473 - up well, despite no plantarflexion taping, and no naproxen.
321474 - ref SDS 4 XVXR
321476 - ..
321477 - On 170604 - hiking did 5 miles until feet too much to conintue.
321478 - Start slow pace on Treat rehab right foot plantar plate tear
321479 - pain level 0, and testing revised orthotic insert right shoe.
321480 - Time 1.25 miles 20 minutes. On Clayton right shoe about mile
321481 - 1.8 began feeling plantar plate pain level 3, but might have
321482 - been metatarsalgia - difficult to differentiate. Considered
321483 - calling Kathy for ride home at Jack-in-the-Box - but continued,
321484 - and problem dropped to pain level 0 - 1. This occurred again
321485 - at mile 3. Turned corner onto Ygnacio Valley Road, and
321486 - considered calling Kathy to pick me up at mile 4.25 - Texaco
321487 - Station on Pine Hollow - continued but called Kathy at mile
321488 - 4.25. Was actually hiking well with pain level 0 - 2, when
321489 - Kathy arrived at mile 5 on Ygnacio Valley Road. ref SDS 4 XWUR
321491 - ..
321492 - On 170605 - letter to Doctor Tang sets out that initial
321493 - lumpiness has mostly resolved. Material tried last week
321494 - directly beneath the plantar plate worked well, but eventually
321495 - hardened. Today, found some "gel" material that may provide
321496 - soft, resilient support for plantar plate section you cut out
321497 - in the orthotic insert. ref SDS 37 B669
321499 - ..
321500 - After reviewing history experimenting to evaluate modifications to the
321501 - right orthotic insert made on 170531, per above, ref SDS 0 UL5I,
321502 - submitted to Doctor Tang...
321503 -
321504 - Dr Sholl's - subsidiary of Merck & Company
321505 - massaging
321506 - gel
321507 - Heel Cushions
321509 - ..
321510 - Today, we considered using this "gel" material to replace small
321511 - section of plyable material the doctor used to provide relief from
321512 - pressure on plantar plate in the modifications made to orthotic insert
321513 - on 170531 0830, ref SDS 32 WS6J, and which later seemed to become hard
321514 - and much less plyable after several hikes, per above. ref SDS 0 KZ9O
321516 - ..
321517 - Pressing this "gel" material reveals some give and resiliance that may
321518 - prevent plantar plate from tearing despite high pressures from
321519 - prolonged hiking.
321521 - ..
321522 - Doctor Tang removed the orthotic insert from the right shoe, which he
321523 - previously modified on 170531. ref SDS 32 WS6J He took the insert
321524 - into a room with a grinder and other tools. He then constructed new
321525 - modifications, implementing ideas in the letter on 170601 1552.
321526 - ref SDS 33 SL8U
321528 - ..
321529 - Doctor Tang showed the revised insert. He retained the original
321530 - material used in the first modification, rather than try the "gel"
321531 - submitted today. He explained the material became hard in the first
321532 - iteration of changes, because surrounding felt material was
321533 - inadequate. Today, he made changes, which are expected to retain
321534 - pressure relief on the planter plate that will prevent further injury.
321536 - ..
321537 - The doctor said to do more hiking with the new changes he made today,
321538 - and send another report to him next week. He will schedule another
321539 - meeting to make any further refinements to the design. After further
321540 - testing, he will send the revised orthotic design out for manufacture
321541 - of new orthotics that incorporate modifications developed from this
321542 - experimentation process.
321544 - ..
321545 - Will have to wait another few days before hiking until the wound on
321546 - the right foot long toe heals, per planning above. ref SDS 0 R57F
321548 - ..
321549 - Thanked Doctor Tang for making time today, for providing timely,
321550 - thorough care.
321551 -
321552 -
321553 -
321554 -
321555 -
321556 -
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3216 -