Applying a Toe Wrap with Two-Layer Cohesive Compression

Hi, my name is Susie Ehmann. I'm a physical therapist with a specialty in lymphedema and wound care. Today what I'd like to show you is one application of a two -layer compressive cohesive product.

Today we're going to be using Coban two layer. The reason we're showing Coban two is it's unique in that it's a product that you can not only use below the knee, but actually can be applied to the entire extremity - from the toes to the knee, and then from the knee to the thigh. We're going to start off by doing toe wraps. What's really unique about doing toe wraps is we want to make sure that we protect the tissues and, in particular the flexor tendons, on the under surface of the toe.

So anytime we're doing toe wraps, we want to make sure that we provide a little bit of protection. I've actually saved some of my scraps of my comfort layer of the Coban two and I'm gonna use that as protection up underneath your toes. So what we're going to do is layer one of each of the comfort layers across the digits. And we're going to start with our toe wrap and we're going to go around the digit starting at the base of the nail bed. And we're going to do 50% overlap. One thing I want you to notice is that I'm not pulling tight. The radius of the toe is very small so you don't need to apply a lot of tension in order to generate pressure.

Again, we're going start at the base of the nail and go proximal. When you get to the bottom of the toe, you're gonna come around the foot and begin on the second toe.

So again, if you don't have a whole lot of toe swelling, you could certainly get rid of the top comfort layer and just use the one on the bottom again to protect that flexor tendon. I use a technique where I put one hand on top and then use my fingertip to work the product through. So again, I'm holding it, using my thumb, pushing it up and through, holding it again, again, holding on top so that I'm not pulling, not applying too much tension, layering 50% as you go to the base of the toe. I can't say that you would do two versus three because every toe is a different length, so but at least two turns. We're going to come around and again, we'll keep using our protective layer underneath our digits, a couple of just kind of take home points is as we're working here again from the tip of the toe to the base, you want to make sure that you're spreading out as you come around the foot so that we don't have multiple layers of the toe wrap right over a bony prominence.

We don't wrap the pinky toe, typically that's because the pinky toe doesn't swell. If you have someone that has toe swelling on that fifth digit, you certainly could do that. The key to toe wraps is making sure that you're not going too tight. So again we're just going to wrap whatever you have left, you just want to spread that bandage out again so that we don't have multiple layers right at the top. So we've got nice even distribution of the pressure for your toe wrap.