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4_PATELLA_Intérêt de la podologie sur les pathologies patellaires - Dr B.BECHET

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4_PATELLA_Intérêt de la podologie sur les pathologies patellaires

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4_PATELLA_Intérêt de la podologie sur les pathologies patellaires - Dr B.BECHET

  1. 1. Intérêt de la podologie sur les pathologies patellaires. Benoit Béchet Pédicure-Podologue 24 février 2016
  2. 2. 2 La podologie à la rescousse de la patella ?
  3. 3. 3 Contexte de littérature ● Très peu de publications. ● Peu approfondies, mal faites, mal interprétées.
  4. 4. 4 1ere étude : action des semelles sur la gonarthrose ● Revue datant de 2005 qui déplore le peu d'articles sur le sujet (8articles sur 1500 concernant la gonarthrose et les semelles) ● Résultats contradictoires : ➔ Action modérée ➔ Mais diminution de la prise d'anti-inflammatoires non stéroïdien et d'antalgiques.
  5. 5. 5 2ème étude : action de la semelle sur la répartition de pression au niveau du genou. Etude datant de 2012 Comparatif sur la pression au cm² avec et sans semelles
  6. 6. 6 3ème étude : association atèle de genou et semelles orthopédiques. ● Étude datant de 2012 ● Association des deux montre une diminution notable des douleurs ● Meilleure tolérance avec les semelles qu'avec l’atèle ● Peu de description du traitement
  7. 7. 7 4 ème étude : évaluation du port d’orthèses plantaires sur métatarsalgies et syndrome fémoro-patellaire ● 90 patients (77 métatarsalgies, 13 sfp) ● 25 % de diminution de douleur ● Pas de détails sur le traitement proposé
  8. 8. 8 Critiques ● Pauvreté de la littérature sur une thérapeutique largement répandue ● Nécessiterait des études plus poussées, plus approfondies, avec une problématique mieux définie ● Au cas par cas ● En collaboration avec des podologues
  9. 9. 9 Recommandations podologiques ● Quand orienter ? Profession de première intention ● Malgré cela il y a très peu de prescription : 2,5 % systématiquement 8,5 % souvent 27 % rarement 62 % jamais
  10. 10. 10 Pour quels patients ? ● Stade précoce de la pathologie ● Pas opérables (âge, maladies, traitements...) ● Voulant retarder ou refusant une opération ● Pour diminuer la prise de médicaments ● En prévention, lors de reprise de sport (après grossesse, obésité...)
  11. 11. 11 Consultation podologique ● Bilan podologique (voire postural) ● Se basant, sur la prescription (détaillée ou non), un précédent diagnostic, des examens complémentaires...
  12. 12. 12 Déroulement de la consultation ● Le podologue prend le patient dans son ensemble ● Examen statique et dynamique ● Plusieurs tests ● Essais de traitement et vérifier sur le moment les effets physiques, palpatoires et visuels
  13. 13. 13 Quelques cas concrets ● Genou valgum et augmentation de l'angle Q
  14. 14. 14 Autres exemples ● Une inégalité de membre inférieur : Peut provoquer un flessum du côté opposé Peut provoquer un varum du même côté etc
  15. 15. 15 Différentes semelles orthopédiques Plusieurs techniques d'approche : ● Classiques ● Biomécaniques ● Posturales
  16. 16. 16 Différentes semelles orthopédiques Différents moyens de fabrication ● Classiques
  17. 17. 17 ● Thermoformées
  18. 18. 18 ● Semelles assistées par ordinateur
  19. 19. 19 K-taping ● Certains podologues sont formés en k-taping et peuvent proposer un tape en attente de la livraison de la semelle
  20. 20. 20 Conclusion ● A la rescousse, oui mais : ➔ Pas dans toutes les pathologies ➔ Si le patient est pris à temps « en première intention » ➔ Pas tout seul (kiné, ostéo...)
  21. 21. 21 Merci de votre attention
  22. 22. 22 Bibliographie ● A. Gélis a, E. Coudeyre b, P.Aboukrat a, P. Cros a, C. Hérisson a,*, J. Pélissier ca Service central de rééducation fonctionnelle, université Montpellier-I, CHU Lapeyronie, avenue du Doyen-Giraud, 34295 Montpellier, cedex 05, France b Centre de médecine physique et réadaptation Notre-Dame, BP 86, avenue Joseph- Claussat, 63404 Chamalières cedex, France c Département de réadaptation fonctionnelle, université Montpellier-I, CHU Caremeau, 30029 Nîmes, France ● Xuan Liu, Ming Zhang. 11 october 2012, hong kong. Redistibution of knee stress using laterally wedged insole inetrvention : finite element analysis of Knee- ankle-foot-comlex ● Richard K. Jones, Christopher J. Nester, Jim D. Richards, Winston Y. Kim, David S. Johnson, Sanjiv Jari, Philippe laxton, Sarah F. tyson Centre for health University of Salford , Allied health professions University of central Lancashire, Salford Royal foundation trust, Salford, Stockport NHS foundation trust, Stepping hill hospital Stockport ● L. Bergera, J. Callejab, M. Maligornec, K. Avenasc a Laboratoire physiologie de l’exercice, campus scientifique, université de Savoie, 73376Le Bourget-du-Lac, France b Centre orthopédie du sport Lyon confluence, 10, rue Casimir-Perrier, 69002 Lyon, France c Centre d’orthopédie du sport, 18, rue Léon-Béridot, 38500 Voiron, Franch

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