Course Name: Podiatric Medical Skills Course Coordinators Marie Mantini Blazer, D.P.M. Course Instructors Marie M. Blazer, D.P.M. Ralph Osting, D.P.M. Kathy Siesel, D.P.M. Scott Spencer, D.P.M Course Code: PMD 222 Year: Spring 2012

Student Syllabus

Ohio College of Podiatric Medicine

2

RATIONALE The podiatric medical skills class is a course in which the basic podiatric skills are learned. These are techniques that are used every day by the podiatric physician to provide a full range of therapy for the patient. Through the use of various padding materials and their placement, the student will learn how to relieve many acute and chronic pathologies of the foot. Padding techniques are essential since every patient is not a candidate for surgical correction of foot deformities. Podiatric taping and strapping techniques are a valuable and useful modality in the practice of podiatric medicine. The ability to apply various types of strappings, bandages, and splints is essential to every aspect of podiatry including surgery, orthopedics, and sports medicine. Podiatric palliative care skills would not be complete without instrumentation and debridement skills. The student must be able to choose the proper instrument and be proficient in its use. Debridement of hyperkeratotic lesions and nails is an integral part of the podiatric practice. The podiatric physician must also be proficient in the debridement of other skin lesions including ulcerations and verrucous tissue to name a few. The student must also be proficient in other skills such as performing toenail avulsions, performing a blood glucose finger stick test, measuring for diabetic shoes, and using the Doppler. Local anesthesia is an essential aspect of the podiatric practice. The student must be proficient in anesthesia skills in order to properly treat painful conditions and to perform surgical procedures. A thorough biomechanical examination and proper orthoses casting techniques are also integral to the podiatric practice. The student must be capable of performing a complete biomechanical evaluation and examination as well as casting for orthoses.

3

MAIN GOALS OF THE COURSE: 1. The podiatric medical student should acquire a thorough knowledge of the basic

padding, taping, biomechanical examination, orthoses casting, debridement skills, toenail avulsion skills, local anesthetic skills, and other skills commonly used in the practice of podiatric medicine.

2. The podiatric medical student will perform basic padding, taping, strapping,

debridement, toenail avulsions, and other skills commonly used in the practice of podiatric medicine.

3. The podiatric medical student will develop their manual dexterity under the

direction of the course instructors. 4. The podiatric medical student will perform a digital anesthetic block and hallux H

block. The students will also acquire knowledge of the Mayo block, ankle block, and other useful podiatric blocks.

5. The podiatric medical student will acquire the knowledge to properly measure for

diabetic shoes, properly perform a blood glucose finger stick test, and perform Doppler testing.

6. The podiatric medical student will perform a biomechanical examination and learn casting techniques for functional orthoses

7. The podiatric medical student will enter their clinical training with the basic skills necessary for patient care.

COURSE INFORMATION The main course instructors are Marie M. Blazer D.P.M. (x 7472) and Ralph Osting D.P.M. (x 7476), and their offices are located on the second floor of the main building in Independence. Office hours for Dr. Blazer are Friday morning and by appointment. Office hours for Dr. Osting are by appointment. Dr. Blazer can be found at The Cleveland Foot and Ankle Institute most days. The class will meet at there assigned times in the podiatric medical skills lab on the 2nd floor of the main building in Independence. INSTRUCTIONAL STRATEGY This is a one (1) semester course which meets once per week for two hours during the spring semester. One-third (1/3) of the class will meet on Tuesday from 8:00 – 10:00 AM, one-third (1/3) will meet on Tuesday from 10:00 – 12:00 PM, and one-third (1/3) will meet on Tuesday from 12:00 – 2:00 PM. EACH STUDENT WILL BE ASSIGNED TO A SPECIFIC SESSION. SWITCHING IS NOT ALLOWED. The class will be further divided for particular sessions per the discretion of the course coordinator. A roster for these sessions will be distributed to the class. Attendance is MANDATORY. This is a "hands on" course. Demonstrations will be followed by clinical skills labs where students will perform the skills and be evaluated on their proficiency.

4

LEARNING RESOURCES There will be assigned reading for each session.

1. PRINCIPLES AND PRACTICE OF PODIATRIC MEDICINE. Levy LA, Hetherington, VJ. (eds.) 2nd edition. Data Trace Publishing Co. Brooklandville. 2006 2. PADDINGS & STRAPPINGS OF THE FOOT. Kaplan C, Natale P, and Spilken T. Futura

Publishing Co. 1982. Mount Kisco, NY. 3. PODIATRY FOR THE ASSISTANT. Donick, Irwin I. Futura Publishing Co., 1977, Mount Kisco,

NY. 4. CHIROPODY: THEORY AND PRACTICE. Charlesworth, Franklin; 5th edition. Actinic Press.

1961. London. 5. THE PRINCIPLES AND PRACTICE OF CHIROPODY. Hanby JH and Walker HE. 2nd edition.

Bailliere, Tindal & Cox. 1960. London. 6. DYE: TECHNIQUE OF FOOT CORRECTION. Dye, Ralph W.; 1969, pages 1 - 41. 7. PROFESSIONAL USES OF ADHESIVE TAPE. Johnson and Johnson. 3rd edition. 1972. New

Brunswick, NJ. 8. ATHLETIC USES OF ADHESIVE TAPE. Johnson and Johnson; New Brunswick, NJ.

PRIMARY PODIATRIC MEDICINE. Robbins JM. Saunders. 1994. Philadelphia, PA.

9. Buell T, Green D, "Measurement of the First Metatarsophalangeal Joint Range of Motion", JAPMA, 78:9:439-48, 1988

10. Burns, L., Burns, M., "A Clinical Application of Biomechanics: Part I", JAPMA, 63:8:394-400, 1973.

11. Cook, A., Gorman, I. "Evaluation of the Neutral Position of the Subtalar Joint", JAPMA, 78:9:449-51, 1988.

12. Burns, M., "Non-Weightbearing Cast Impressions for the Construction of Orthotic Devices", JAPA, 67:11:790-95, 1977.

13. Neale’s Disorders of the Foot. Lorimer D, French G, O’Donnell M, Burrow J,and Wall B. 7th edition. Churchill Livingstone. 2006. Edinburgh.

STUDENT EVALUATION Attendance is MANDATORY. An unexcused absence will be an automatic failure for the class. Attendance will be taken. Excused absences need to be made up as soon as possible and before the last session. It is the students’ responsibility to contact the instructor for the make up session. Tardiness is unacceptable and can result in a failure or professional deficiency per the course coordinator’s discretion.

5

READ THE ASSIGNED READINGS OR SECTIONS IN THE HANDBOOK PRIOR TO COMING TO CLASS!!!! Students must have all of the proper instrumentation needed for class!!! Bring instruments to all classes including the 1st day. Failure to bring proper instrumentation is unacceptable and can result in a failure or professional deficiency per the course coordinator’s discretion. Students will have satisfactorily completed all skills required in this course. Any anticipated problems with completing any of the skills need to be addressed with the course coordinator before or on the 1st day of class. Not performing all skills can result in a professional deficiency or a failure per discretion of the course coordinator. Incomplete or unsatisfactory skills will be remediated during the course or scheduled during final exam week. Attendance along with end of semester practical exam will serve as the sole criteria for passing this course. The student will keep a checklist that will be signed by the instructor when the skills assigned for that class have been completed. The checklist will be turned in at the practical exam. A practical exam will be given during the last week of class. Two skills taught during the semester will be chosen at random for students to perform on the practical exam. Skills not passed will be made up the next week or per the discretion of the course coordinator. A written component of the final examination may also be given. This is a pass/fail course. 1. Attendance is REQUIRED. Students must make arrangements with one of the

course instructors before class time when missing a class. In cases of illness etc., the student must call/e-mail one of the course instructors within 24 hours after the class and leave a message with the Podiatric Medicine Department secretary that morning to be excused for that class. The student must then arrange to make up that class. EVERY ATTEMPT SHOULD BE MADE TO ATTEND ALL CLASS SESSIONS. CLASS ATTENDANCE IS ESSENTIAL FOR PROPER LEARNING OF THESE SKILLS. AN UNEXCUSED ABSENCE IS AN AUTOMATIC FAILURE FOR THE COURSE!!!

2. Students must satisfactorily complete all skills in order to pass this course. IT IS THE

RESPONSIBILITY OF THE STUDENT TO MAKE UP ANY MISSED SKILLS. 3. Students must satisfactorily complete the final exam in order to pass the course. 4. STUDENTS WITH AN UNEXCUSED ABSENCE WILL RECEIVE A FAILING GRADE FOR THE

COURSE.

6

INSTRUMENTATION Students must provide the following:

A. Scissors – a. one pair of moleskin scissors (preferably curved sharp/blunt

utility/surgical scissors) AND b. one pair bandage scissors

B. Instrumentation necessary for skills 1. Nail nippers – need two sizes – one large curved and one small straight nail nipper 2. Tissue nippers

3. #3 Scalpel handle 4. Large chisel handle 5. Small mini handle 6. Double ended curette 7. Double ended nail rasp

8. Hemostats: Kelly straight hemostat and curved mosquito hemostat

9. Packer and spatula 10. Electrical debridement instrument a. snap on mandrel b. snap on sanding disks c. pear shaped burrs 11. English Anvil (optional) 12. One Orange 13. Glucometer with testing strips 14. Orthopedic examination device (OED) or tractograph

7

SCHEDULE

SESSION 1 ORIENTATION 1-3-12 PADDING OF DIGITAL LESIONS DIGITAL STRAPPINGS Read corresponding pages in Podiatric Medical Skills Handbook 1. General Principles of Padding/Taping 2. Instruments Used in Clinic Podiatry 3. Materials Used for Taping and Padding 4. Demonstration of Topographical Anatomy 5. Discussion of Preparation and Tape Removal 6. Heloma Durum Pads 7. Heloma Molle Pads 8. Buttress Pads 9. Tube Foam 10. Digital Strappings for Extension Limiting 11. Buddy Splinting SESSION 2 PADDING OF HAV AND TAILORS BUNION 1-10-12 PADDING OF PLANTAR LESIONS Read corresponding pages in Podiatric Medical Skills Handbook

1. HAV and Prehensile Strap 2. Tube Foam 3. Tailor’s Bunion Padding 4. Metatarsal Head Lesion Pads/Aperture Pads 5. Dancer's Pads 6. Metatarsal Pads 7. Removable Metatarsal Pads

SESSION 3 BLOOD GLUCOSE FINGER STICK TESTING 1-17-12 DIABETIC SHOES OTHER OFFICE TREATMENTS Read corresponding pages in Podiatric Medical Skills Handbook 1. Verruca Treatment and Padding 2. Measuring of Diabetic Shoes (Appendix A) 3. Blood Glucose Finger Stick Testing

8

SESSIONS 4 LOCAL ANESTHETIC SKILLS (SESSION #1) 1-24-12 Read corresponding pages in Podiatric Medical Skills Handbook Read Chapter 39 in Principles and Practice of Podiatric Medicine 1. Discussion of Local Anesthetics 2. Digital Anesthesia Block

3. Discussion of Sinus Tarsi, Neuroma, and Plantar Fasciitis Injections SESSIONS 5 LOCAL ANESTHETIC SKILLS (SESSION #2) 1-31-12 Read corresponding pages in Podiatric Medical Skills Handbook

1. Hallux Anesthesia H-Block 2. Discussion of Mayo Block and Ankle Block

SESSION 6 NAIL AVULSIONS 2-14-12 DOPPLER EXAMINATION Read corresponding pages in Podiatric Medical Skills Handbook 1. Discussion on Nail Avulsions 2. Nail Avulsion Procedures (Appendix B) 3. Doppler Examination (Appendix C) SESSION 7 FOOT STRAPPINGS AND UNNA BOOTS (SESSION #1) 2-21-12 Read corresponding pages in Podiatric Medical Skills Handbook 1. Low Dye Strapping with Campbell’s Rest Strap 2. Variations of the Low Dye Strapping 3. Heel Spur Pad with Box Heel Strap 4. Derotational Foot tapings 5. Unna Boot (Appendix B) SESSION 8 FOOT STRAPPINGS AND UNNA BOOTS (SESSION #2) 2-28-12 Read corresponding pages in Podiatric Medical Skills Handbook

1. Continuation of Foot Strappings and Unna Boot

9

SESSION 9 PODIATRIC INSTRUMENTATION & DEBRIDEMENT SKILLS 3-06-12 OTHER STRAPPINGS TECHNIQUES Read corresponding pages in Podiatric Medical Skills Handbook 1. Demonstration of Instruments used in Palliative Care

2. Demonstration of Proper Use of Instruments 3. Practice of Debridement Skills – bring an orange to class! 4. Various Ankle Strappings

SESSION 10 BIOMECHANICAL EXAMINATION (SESSION #1) 3-27-12 Read corresponding pages in Podiatric Medical Skills Handbook Watch corresponding videos in OCPM library- Ask Donna

1. Biomechanical Evaluation and Examination (Appendix D) SESSION 11 BIOMECHANICAL EXAMINATION (SESSION #2) 4-03-12 Read corresponding pages in Podiatric Medical Skills Handbook Watch corresponding videos in OCPM library- Ask Donna

1. Foot Orthoses Casting Techniques (Appendix E) SESSION 12 REVIEW SESSION 4-10-12

1. Students can practice all skills

SESSION 13 PRACTICAL EXAM (1st half) 4-17-12 1. Written or Oral Section to Be Announced

2. Two Skills Chosen at Random are Tested SESSION 14 PRACTICAL EXAM (2nd half) 4-24-12

1. Written or Oral Section to Be Announced 2. Two Skills Chosen at Random are Tested

10

STUDENT CHECKLIST NAME: SESSION # INITIALS SESSION 1 _________ SESSION 2 _________ SESSION 3 _________ SESSION 4 _________ SESSION 5 _________ SESSION 6 _________ SESSION 7 _________ SESSION 8 _________ SESSION 9 _________ SESSION 10 _________ SESSION 11 _________ SESSION 12 _________

11