Hi, Doctor Pelto here. I'm going to go over a little bit about the the self pay products that we have in the office. This is for 2024. We have a lot of different items and I think this will help the staff and also some of the new doctors coming in to kind of explain what we have. This is a list of everything and I'm going to go through these things one at a time here all the way up to EU shaped bone pad. So let's talk a little bit about this. The first one is an Achilles wedge.
This is used, you can see here it has different levels and this is kind of like an adjustable heel lift for your shoe, but it's used in a walking boot. In a Cam boot, you put it in the bottom of the Cam boot, it lifts up the heel quite a bit and this reduces the pull on Achilles if someone has an Achilles tear and they want non surgical treatment.
So by lifting up the heel that much it's going to allow the two ends of the Achilles to come together and this can be used, it reduced the pull and it can also be used after surgery as well. This is something that we use for those types of Achilles and then you slowly reduce the levels that go into there. That's how this Achilles wedges A Mara gel care lotion. This is a that we call it a Mira
gel blue. It's a lotion that patients can put on their on their feet at. The nice thing is it's it's safe to use between the toes. Not safe, but safe between to use the toes if you have diabetes. So it's not going to get it very damp between there. It's good for the dark coloration on the legs. Those are called hemociterin stains in the front of the legs. It's good for that venous dasis dermatitis. It's just a daily lotion that can be used.
I think it's better than some of the other ones that can you can buy commercially and it's good for cracked heels if you have really, really fissured and really, really thick. There's something else that's a little bit better than this one. But this is, this is good for dry skin, cracked heels and things like that. OK. I'm called the Mira gel blue patients. They can just get it on the way out of the office here.
Mira gel red. This is used for kind of wounds and ulcers, whether it's the ones that we make when we remove a wart or whether someone has a diabetic ulcer pressure ulcer, cutter abrasion. So you can use this on diabetic ulcers that are small. You can also use it if you're going to be doing like in a matrixectomy type of procedure, something where you're going to be creating a wound and you're going to want that to heal quicker.
OK. So that's where you use these for matrixectomies in this kit specifically. So in this kit, this is called an Ameri gel post op kit. It has the Ameri gel wound dressing, It has a wound wash which is like a saline wash It has gauze pads and it has band aids and you kind of put those together and you put those on the on the toe. So you can use this for different things. We specifically use it for
matrixectomy and what removes. It has a whole, It has enough for the whole post op period and it's easier than soaking twice a day, which is what what typically happens and it's good for wounds so they can use it anywhere they have a wound. You don't have just have to use it on the foot. You can use it afterwards anywhere that you want. Biofreeze this can either come as a gel roll on or a spray. Biofreeze is used for pain reduction for arthritis and
other types of foot pain. It gives a temporary reduction has kind of like a menthol smell to it patients. They they like the way it feels, make it feel better. I think it it kind of takes away the pain feeling and gives it that cold feeling. So it kind of masks that that pain for for a period of time. This is something that patients can get in the office as well. Body Glide. This is used on the foot specifically or in other parts
of the body it use. It's used to reduce friction, so you can put it on the bottom of the foot if there's calluses that are there. You can also use it between your legs, armpits and other areas of chafing for runners and for other types of athletes, but it can be used also in the bottom of the foot if there's painful rubbing causes in these calluses. Bromi talc is a basically just a talc for for dampness for people that have hyperhidrosis or dampness in their feet. Athlete's foot have odor
problems in their shoes. You can use this type of a talc for that bromi lotion. This is used with excess perspiration or hyperhidrosis, and it's an antiperspirant lotion that you could put on the skin as well. So a booten splint. There's a couple of types of toe pads that we use in the office. This is one. It either comes in a single strap or double strap and it would it used to pull down hammer toes, so it reduces the pressure to the front of the foot because of this padding.
But it also kind of relocates that hammer toe that's stuck up. It pulls down the hammer toe so it can fit easier in shoes. So some patients that just can't fit things and shoes, they wear these. It pulls over the toe to make sure it's. But yeah, this is something it goes over the toe but you want to make sure it's not too tight especially in patients that are diabetic because you don't want to cut off the circulation. So you have to make sure that
these aren't too tight. These last, you know depends on how often they wear them, a couple of weeks and then you can you can do other things. But this is kind of a non searchable approach for bringing those second toes back down and some of these other toes Cam Walker sole cover. This is used for someone has a walking boot and they want to keep it dry in the rain or the snow. This is something that patients can get us an additional add on
for their walking boot. This is also another add on that can go both into The Walking boot or into the surgical shoe. It's called a peg assist. So this peg assist, what it is it, it has these little pegs that can be pulled out in areas of high pressure such as ulcer areas and then it can be put in, it's used to offload them. Here are some instructions. I'll give you guys the slides if you want to look at those. Those different instructions on their website.
Carbon fiber plate, there's different types of carbon fiber plates. There's some that only go to the toe and have the back end. There's some that go totally these fit in the shoe and these used to reduce jamming in the joint, especially for people that have house limited. So when they're walking it makes it nice and rich in the front so it doesn't bend. This can be used for any part of the foot that you don't want the foot to bend.
Another way of doing this is with a hard soled shoe such as like a running shoe or a hiking shoe. That can be beneficial with these carbon fiber plates or just like a really stable shoe. These can go on people's shoes. These are the Canterbury laces. These are laces that have these little balls on them. And these little balls, what they have is a rubber core that allows the elastic to kind of
pull back and forth. And you put these in your shoes, you put them out one end and it keeps like an the same type of tension across it. It's good if people have like bone spurs on the top of their foot. It's easier than tying your shoes and and they say it improves circulation. So there's no numbness on the top of your foot when you're wearing the laces, it doesn't over tighten that area. They're called Canterbury laces,
cluffy wedge. This is something that goes in the shoe and it goes underneath the big toe joint. So you have the the hallux, the big toe and it actually lifts up the the toe and it allows the bone to drop down. You put this underneath the big toe. This can either be added to an orthotic or just added to a shoe and this is made to reduce joint jamming. Once again for someone that has Hallux Limitis or reduced range of motion in the big toe joint or functional Hallux Limitis
where it's not moving as well. So this is something else that we have here in the office. This can be either added to an orthotic or it can just give out solely. These are our CMP socks. I think it's good to show these. These are usually given along with a water bottle to those that get orthotics. They can be purchased. They're a good sock. They have a compression in them, so they're very comfortable. They're like a running sock for patients Cobanth, 3 inch and one inch.
So patients are getting these to splint, sorry not Sprint. They're used to splint the toes together with a fracture or instability. You can also when you drain a cyst you can wrap it around so that cyst doesn't fill back again fill back up again and it used used for toe band which is in the three inch Co band is used after draining A cyst or hematoma used to reduce swelling as well.
And this can also be used you know as a dressing for for patients and if you have like a a fracture or a a toe that you're wanting to buddy tape 2 toes together that can help for that. This one inch coban you have to be careful when we do flexor tenotomies in the office then we use the one inch coban afterwards to keep that toe straight. Once again, you want to be careful with patients that have poor circulation that is not on too tight or not on too long. That could cause circulatory
problems. Corn pads. Here's an example of a corn pad. It goes right in the side, can either go on, on the outside of this would be like for a 5th digit, it can go between the toes, could be on the top of the toes. They have adhesive on one side. They're used to offload painful corn areas. We usually use them in office with selenocane if we're doing a
porokeratoma. So we're going to put selenocane inside of this little hole and then put a Band-Aid on it and that's going to Slough off some of the skin. It can be used for painful calluses between the toes as well to to space them out. Here's an example of correct toes. So correct toes are to be used to space out the toes, if they can be used. They're supposed to be using wish shoes. They they come in different sizes. They help stabilize the toes and prevent worsening of hammer
toes. Bunions they don't. I don't say that they reverse them, but they can help prevent the worsening of them. They're made to wearing shoes for many patients that wear toe socks along with them. Go slow when you're starting out with them. I usually say one hour per day, very similar to breaking in an orthotic, and it's common to have tendon pain when wearing
them. Even painted to the front of the legs if you're not used to wearing them, because it's going to kind of stretch out everything when you're not used to it. And many times it might be modified. To put some videos here. There are modification instructions of the most common modifications and also when they get them. There's AQR code that has some interesting modifications.
The most common modification is trimming out this little area here on the 5th toe because it pushes the 5th toe over a little too much. Crest pads. These are pads that are going underneath the the toes right here. The and it straps on the 3rd digit. It's It's made for hammer toes. This can also be added into an orthotic called the Crest pad. It's used to support hammer toes to not hit the front of the
ground. So basically if you have a really painful callus to the front of the toes, it can help or ulcer to the front of the toes, make sure it's not too tight once again and mostly you put this on 3rd digit. Now how do you tell what side is what? Usually the big side goes towards the big toe, so the big side goes towards the big toe. If you're looking of if you're unsure what is right, what is the right one and what's the left one on the for the foot. Custom diabetic inserts.
These are inserts. They're called multi density because they have three different densities or two different densities of material and this difference in density allows less friction on the bottom of the foot. It's used to offload calluses or high pressure areas. It's it's not used when an ulcer is open. When an ulcer is open, normally people are in a walking boot or a surgical shoe. You can sometimes do a custom orthotic because it does a better job at offloading.
These ones, they they collapse down in the edge, so they're not really made for really big people because they're going to squish them right down. They're not going to do anything. I find a custom orthotic or something that has a better shell that's made of a harder material works better. These tend to be prescribed with diabetic shoes. We no longer do diabetic shoes in the office but we do sometimes order these for for patients. Digipads here is an example of
some Digipads that are used. These can go on the on the on the toes. So they have this the gel part right here and they have this almost like a a a woven sock that goes so there's a hole here and you put it on the toe. This can go on any of the toes that have painful calluses and helps the toes not to rub together where there where there is pain even up. This is used with a The Walking boot. You can see someone with a walking boot here and it throws the hips off.
This is the even up with The Walking boot. Their hips are more aligned and their gait is aligned. It's offered with everyone that's getting a walking boot. We recommend it. The staff are the ones that usually talk about it. It helps to avoid hip and knee issues due to walking with the boot being higher on one side than the other. Another option is to wear a shoe
that has a higher heel. So some females that can wear a high heel, higher heel shoe, but a lot of people don't want to wear that all the time so that's called an even up formula. Seven. This is the the the medication that we have in the office, that's it's a it's anaphylate, it's 1%. It's an antifungal solution. It's used for nail fungus. You apply it twice a day and it's dispensed only in a doctor's office. So it's it's the one that we carry. We don't carry a lot of things for nails.
We tend to do more like oral medication and things like that. But this is if someone who doesn't isn't a candidate or they want to do something in combination with the oral or laser treatment, they can do this. We're going to get into some of the pads. There's a lot of different pads that we use. This is called the the ball of foot cushion. This is used for metatarsalgia or pain to the ball of the foot. It's used for pain for pain for calluses. It doesn't work specifically on calluses.
Usually have to trim the calluses down first if there's callous to trim and then you can put it on. If there's a really big callus, you have to take that off first. If there's a prominent bone in the bottom of the foot because of lack of fat pad, this can help as well. So for example, if the patient has a has hammer toes that kind of go up and there's a prominent bone there, or you can feel just the bone instead of the fat that's usually on there, you can
use these. These can also be added to an orthotic, these metatarsal pads, that's what they're called, ball of foot pads. There's also arch pads, so these can be used if someone has a painful arch. They have high arch, weak arches, low arches, things like that. They can be. These are reusable. That's the benefit of this pad as well. These are reusable. What you do is you wear them and then you pull them off at night and then every few days it's going to get stuff stuck on
them. So you wash them with soap and water and the stickiness will come back to them. All these gel pads are the same way. They they work well. Once again, this tries to lift up the arch a little bit. Once again, it can be done in orthotic as well. These are all like temporary things that you could try before you would make some unorthotic. Same thing, Same idea, but this is called the gel U pad. This is AU because of the area of pain you would cut out right
here. So if there's a painful callus this would go all around that callus. You would trim the callus or the poral keratoma off. You could also use it to offload an ulcer, but usually an ulcer or you may be used for a pre ulcerative callus. That means a callus that's could be an ulcer in the future. Usually for an ulcer you're going to offload them in a surgical shoe or a walking boot heel cups.
These are used for cracked heels along with some of the the heel sleep, heel socks and urea creams. They can also be used for for painful heels to offload to change the the pressure point. So a heel that is lacking some fat on the bottom so it's a a fat pad atrophy or just a a painful heel that you want to try to squish it. Some patients do well with this, some kids with severs do well.
Some kids with some people with plantar fasciitis do well with these just to change the pressure point of of the of the heel and it kind of puts the pressure more to the sides than in the center. There are small and and large sizes and the the way to remember it is there's a sticker on them and you always step on the sticker so that when you tell patients they know what side to put up that the bottom part is the one where the sticker is OK. That's the easiest way to remind patients.
Adjustable heel looks similar to what we looked at with the Achilles tendon. There is the adjustable heel lift as well, and this has three different levels you can see here, and you take these out, you can leave it in for a week or a month, it depends on how long you're going to be using it. It's it's used to reduce some of the pull on the Achilles and there's three levels used for
Aquinas and Achilles tendon. You gradually reduce the height every two to four weeks and it can also be used for a limb length discrepancy. So if someone has a a longer limb you can put this in one of the shoes and not the other shoe. It's called the adjustable heel lift. This is a more expensive version of this one. This is a PPT lift. It's just instead of there's three levels right here you can see this one only has one of those levels and it's it's PPT.
So it it it has a cushion to it so it's going to kind of bottom out can be used for them length discrepancy and it's it's 1/4 inch so it's smaller heel so smooth. These are heel socks that we use for patients that have really bad cracked heels. We talked before about the Amira Gel blue. You can use Amira gel blue, but this really works better if there's bad cracks. So used for cracked heels, use this in conjunction with urea
cream. So you can either put these on by themselves at night and then in the morning put on the urea cream. You can put them on together. If you put them on together though, it makes it dirtier because of the the cream that goes with the sock. But it's really good for dried cracked heels, the heel. So smooth heel sleeves, this is the other aspect to that. It's called a Cara combo. It's a pumice or pummy bar along with the Kara 42. This can be used along with this
other sock. OK it the the cream is used to reduce callousing as well as cracks or fissures into the heels. It can be used with the pumice one to two times a week after showering. So you use the pumice, usually in the shower. And the pummy bar does not 'cause friction as a pumice stone does. Be careful though. If you use it all the time, it's gonna cause skin sloughing, so the skin's gonna be sloughing off. The patients might come in wondering why their skin is kind
of sloughing off. This is the cream by itself, so there's a combo. There's a little discount if they do it with the combo. This is the cream just itself. OK, here's Cara nail gel. So Cara nail gel is used for thick toenails. It makes it easier for them to trim. It's made of tea tree oil menthol and it just makes it easier for it to trim it.
I don't, I don't say it, it clears the fungus, but it just makes it easier to trim for some patients that have really thick nails that have a hard time trimming them on their own. That's the care and nail gel. Carey Flex This is an example of how to do Carey Flex. You take a a bad looking nail, you trim it all the way back and you make a kind of a fake nail on top of it. There's different steps to it usually stays on about three months.
For the return application. There's usually a reduced price for the second application and the kit. The patients can bring it back themselves. Usually does 2 to 3 nails. Most patients come in the spring and the summer for this and they can apply nail Polish and use acetone remover afterwards. So it's a real simple thing Here there is an example of how to do this with this video. If you want to watch this video, you can you can do this. This kind of explains how to do it.
You have the nail that you trim off all the way back to where it's attached. The first part you do is you there's a bonding agent. You apply the bonding agent and then use a little light and then you do the resin. You do a first application a little bit and then you put it underneath the light for usually 30 seconds initially just to harden it. Then you do another second step as well to make it look pretty and then afterwards you grind it down to make it look more like a a normal nail.
So and then you. And then you put the light on again. So that's how you do it in the office. There's a couple of different types of lights that you can use. We have two different lights. One is the carry flex light and the other one is for the Anifix with the kind of two different lights that we use for this. KT taping is used to reduce
strain on tissue. What it does is it actually lifts up the skin to allow increased blood flow to the area and reduces muscle soreness and provides flexible support. So we can use this for the Achilles for the plantar fascia, we do have KT tape in the office for for patients Lems. These are shoes that we sell. We sell these. We have usually the basic colors, but they can order them through it through US. No one else really has them. So we're one of the distributors.
It's a zero drop shoe. It has an anatomic toe box. It's lightweight, it's good if a patient likes to go barefoot, and it can be worn with some orthotics, but many do not wear with orthotics and we sorry, we carry them in the office. There are different types of shoes that we recommend. Usually it's ultras, Topos and Lens. They're more of an anatomic shoe. This is a like that other pad that we saw before, the gel pad.
This is a metatarsal pad. It's APT the same thing as that other lift that we saw, and it it used to offload painful metatarsal region. It this is applied directly to the shoe, though the other one was applied to the foot itself, it's stuck on. This one sticks to the liner and once again it can be incorporated in an orthotic.
If someone has an orthotic or you want to test it out on top of their current orthotic and you have to determine what's right and left, this is always a struggle for the staff. This is an example of the right one. Once again, the bigger part goes on the medial side or towards the big toe. That's how you can tell the larger part indicates the the medial part or the part that goes towards the arch region is the bigger part for you when you're looking at the right or left.
This is an example of a metatarsal pad that can be applied similar to the gel one that we saw before, but this is a felt one and this is attached to the foot. I find the gel one just work better because they can be reused. This is more of like a temporary thing. Mycol Mist is used to spray our shoes, the shoes of the patients.
It's less harmful than Lysol. You spray it in the shoe and you put them in a plastic bag overnight and we tend to use this in conjunction with the shoe sterilizer. For patients that are dealing with athlete's foot or nail fungus, it's called Mycol Mist splay or Naboso splay. These are similar to the correct toes, but they're one-size-fits-all and they don't have different sizes they're used to wear with anatomic shoes.
They're less expensive than the correct toes, and here's some links to some webinars if you want to learn more about them. Northwest Dress Sets. These are some dress orthotics that we do for patients. Let's say they wear a dress shoe or they wear flats. This is an example of one that you can put in their flat flats. This is one for there's high
heel one as well. They take up less room than normal orthotics and they can be used for under 3 inches, which is this one, or over 3 inches, which is this higher one. If you want more information from Northwest, you can click the link that's there as well. These are prefabricated children's orthotics that we have. They come based on colors and you hold them up to the arch of the foot and they have, they have a deep UCBL type of device for for a flexible fat flat foot.
Once they don't fit then we get the patients into a custom device. We see the patients back usually yearly to make sure they're fitting well and then they can get the next size up that usually it's every year to year and a half they're going to go up a size. When the arch is is hitting too far forward, it's time to get a larger size. So when this arch right here is fitting, hitting too far forward and their foot, they'll be in
for a new pair. But now when I use tell patients, they don't create an old arch. I tell the parents that they just really give us stability for the heel region and they help the the foot to function a little bit better. This is an example of some of the orthotics. Now we have two different friends that we normally use in the office. One's called forward motion and one is called a Northwest. For all the orthotics, I tend to say that they last about five
years. This one's a little bit less expensive than the Northwest one. That Northwest, some of them can be a larger device and we use a foot scanner. Here's a link to their website. This is an example of one from forward motion. A lot of times we use a full length one. This is their prescribing paper. I just wanted to go over this a little bit because when we're filling this out for patients, we want to know if we're going to do a functional orthotic and athletic address an accommodative.
This is like with for the diabetic ones, the accommodative similar and then there's some children's, this UCBL and some of these gate plates. So this is all in the app that we have now. But this is just an example to kind of explain things. There's different shells that we we might want to do like a graphite is a typical one, or polypropylene which are common ones that we do.
Then we put the arch height that we want, low, medium, high or total contact if it's a very high arched foot flanges, which are little extensions that can go both on the inside medial and lateral. A mild medial is good, a bit whole medial might be really hard for someone to fit. There's a lateral, a deep heel cup. Then you want to talk about the heel cup. Usually we do the the deeper the heel cup, the more stability the
foot gets. The OR thought of width most are normal but if there's a really wide foot we'll do a wide and then there's different postings that you do. You might want to do extrinsic posting. Most of the time we do intrinsic posting unless it's a very flat foot and there's different top covers. Eva Vinyl leather neoprene is one for like athletes, diabetic micro pores at Cushionier one and you can see these all on
their website. And then the top cover length you can either go just the shell only like this previous picture I showed you. This is the shell only. You can go to the sulcus which is underneath the toes or you can go full length and there's different types of padding that you can put in there. And then these are different accommodations similar to the accommodations we talked about before that we can put on the on the shoes or on the foot. There's metatarsal pads, arch pads.
First Ray cut out to help the first Ray move better morning's extension to to not allow the big toe joint to move as much for metatarsal cutouts, for painful calluses, arch reinforcements, amputee sponge fills, dancers, pads, those are to offload the different areas of the foot. So that's that's an example of the forward motion. Here there's an example of the Northwest orthotics. These once again used the last five years. They're a little bit more expensive than forward motion.
The carbon fiber is very comfortable for our patients, takes up less space in the shoe. They have a very good posterior tibial tendon or very for flat feet is a very good device. Here's a link to to those ones. They have a little bit more of a complex prescription, but they do have these. You can select like what they're being used for, like if they have flat foot or plantar fasciitis, you can just pick this and it'll put in all the other things for you, which
makes it a little bit easier. If you want to use one of their setups, they have one very good super glass, one for posterior tibial tendon or flat foot that that's a very good one for our patients. They have dress ones. You can pick once again the type of foundation, the type of top cover, the types of cushions, which is very similar to the other ones. Here are the activity like on what's included in the orthotics and here's all the different
pads that you can add to that. We'll do a different one later on. That's going to explain a little bit more about that. We have an offer with a second pair of orthotics within six months at $200 off. This goes in with every orthotic that patients get and then put it in there so they can use this for dress shoes, gym shoes, soccer cleats, golf shoes, ski boots, cycling boots. So something that the staff should offer to the patients.
They extend this for six months helps increase compliance and and improvement and it's good for for a lot of our patients. So you can just be offering that to them as well. There's some orthotic add-ons I want to go over. There is refurbishing so many times the top cover gets worn out and it usually about a hundred $100 and then but it's less than the price of a new pair.
The orthotics are protected against cracking, so usually they do a new pair for free if it cracks, but if they just need to refurbish they drop it off and many times we'll scan them for a new pair, get them a new pair and then refurbish the old pair so they'll have a second pair. There's a rush charge if they want quicker production, like if they're traveling or going to school, there's an orthotic scan only, and this is for for example, Pediatrics.
If they outgrow the orthotics, they they don't have to pay for the whole device, they're just a scanning fee and there's an orthotics or shoe shipped to the home. So this is usually for students or people living in another state another part of the year so you can ship things to them. There's a little add on fee for that. This is a plantar fasciitis sleeve. This is a compression sleeve that can be used around the
foot. This is the proper way of putting it on. It comes in different colors. It can be used for plantar fasciitis. It's called the plantar fasciitis sleeve, but it can be used for anything where they're swelling. You can use different fractures for tendonitis for swelling, and you can even use it to transition after they're in. An ankle brace for an ankle sprain.
Here is an orb massage ball. So this is a massage ball that's used to reduce soft tissue tightness, Helps improve soft tissue recovery for the quads, IT band and hamstrings. Here's an example of a pro tech Achilles sleeve. This has some these bladders here of of air or cushion that help reduce by putting compression on the Achilles. It's for non insertional Achilles pain to make it feel better. This is an example of a foam roller. There's a couple of different
types of foam rollers. This is a contoured foam roller that penetrates a little bit deeper. You can use it for the calves, for the quads, the IT hamstrings, things like that. This is one that's a little bit easier to travel with because it has a hollow roll in it, hollow hole and you can when you travel, you can put your clothes in there and it's easier to fit in there, but it's the same
thing as the other one. This is a just a mini ball, but this is more of the foot or different areas of the calf that prototes flexibility. And this one you can heat up so it has some kind of softens the soft tissue as you do it. Here's an example of the pummy bar that we use similar type where it buffs off as you're using it, it will disintegrate. OK, you use this along with the cream. It doesn't really 'cause friction in using the shower to remove any of the dry callous skin.
Once again, if patient's a diabetic, you have to be careful not to cause any sores if they scrub things too much. Here's an example of the Shoos app. This is the one that we're using currently. Use it for 15 minutes and it's usually done with nail fungus treatments like Luneola or Lamisil. It can help kill the fungus and bacteria that cause athlete's foot, fungal nails, foot and shoe order and and diabetic infections. So here's some example.
You can go to their website to look more about it, but it's helpful for for patients for their shoes versus buying new shoes all the time. This is an example of a shower bag. This can be used for both a cast and also if patients have surgery and they have sutures or stitches. My patient, our patients usually leave before they have surgery with these and that I recommend they try these on before surgery to make sure that there's no leaks. It doesn't leak in.
This is an example of a toe alignment split. We don't use this that often, but occasionally with a bunion or a hammer toe, we want to hold things in place. And these are little straps where you can kind of pull the toe down and stabilize it to this Velcro piece right here. So it can it can stabilize A bunion or a hammer toe or a tailor's bunion. Here are some toe caps. These are gel toe caps. These are good for the big toe
and the smaller toes. They can be helpful for painful calluses on the tops or the tips of the toes, and they can reduce pressure. They're not directly supposed to be used on ulcers, but they're usually used to prevent the ulcers from happening. Another type is a silicone tip once again for a painful callus or an ulcer region that you want to a pre ulcerative callus that you want to reduce that rubbing from toe spreader. This is used to spread between
the 1st and 2nd toe. The biggest problem what this is it falls out all the time so you have to put socks on and try to find it if you lose it but it works quite well just to space out. Some people feel better if you just space out the bunion from the second toe, just pushes it over a little bit, helps realign the joint and makes some people feel better. This is a gel. This is AU pad that's made out of felt that we have.
I think we have the felted ones or foam ones in the office and you stick it to the bottom and instead of felt it's foam. We have this felt and it sticks on the bottom of the foot and it offloads areas the similar to the gel one, but this is just made out of a different fabric. It usually has adhesive on one side and it can be placed also on the on the sock line or in
the shoe for the patients. So the next one we're going to go over is durable medical equipment, but we're going to stop this one for now.