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PODIATRY Home

PODIATRY  2004

PODIATRY 2004

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Subject:

Re: Toe Gallows

From:

"Dr. Stanley Beekman" <[log in to unmask]>

Reply-To:

A group for the academic discussion of current issues in podiatry <[log in to unmask]>

Date:

Thu, 9 Dec 2004 23:03:37 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (250 lines)

Reply

Reply

Maire,

Toes act as a radiator, and the arterioles act as the thermostat. When the
body gets cold, the arterioles (thermostat)  do not let the blood
(antifreeze) go to the toes (radiator), so the body temperature does not
decrease.
This is unrelated to mechanical obstruction of the blood vessels.
So you can rest assured that the toe should be able to handle a tourniquet
for much more than 10 minutes.

Respectfully,

Stanley


At 08:15 PM 12/9/04 +0000, you wrote:
>Thanks Phil.
>
>Stanley, toes become necrotic when subjected to extremes of cold more quickly
>than the rest of the foot. Surely this would also be the case when applying a
>tourniquet.
>
>Maire
>
>
>----- Original Message -----
>From: "Philip Mann" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Thursday, December 09, 2004 7:25 PM
>Subject: Re: Toe Gallows
>
>
>Hi Marie,
>
>just to say I am with you on the 10min side of the fence, but we use
>Tourni-cot Tourniquets and on the tag attched to them it says in large red
>letters "Do not apply for more than 90 minutes" ! These tourniquets are
>designed only for digits and other small apendages.
>
>All the best
>
>
>Phil
>
>
>
> > Maire,
> >
> > The main difference is that there is no muscles in the toe. Muscles have a
> > higher metabolic rate than connective tissues. So oxygen deprivation
> > effects muscles more.
> > So I would assume that toe tourniquets are safer.
> >
> > The big risk would be a diabetic with plaque in the blood vessels. I
> > assume
> > your dominatrix would not perform a vascular exam prior to the vascular
> > insult. If a piece of plaque would break off, there would be a problem.
> >
> > I also think that you can give information in a round about way. "If I
> > were
> > to tell a dominatrix the safe time to use a tourniquet, I would say 10
> > minutes, but I wouldn't tell her"
> >
> > Sincerely,
> >
> > Stanley
> >
> > At 08:47 AM 12/8/04 +0000, you wrote:
> >>Thanks Stanley,
> >>
> >>I think it might be a different situation with a toe tourniquet.
> >>
> >>Maire
> >>
> >>----- Original Message -----
> >>From: <mailto:[log in to unmask]>Dr. Stanley Beekman
> >>To: <mailto:[log in to unmask]>[log in to unmask]
> >>Sent: Wednesday, December 08, 2004 2:02 AM
> >>Subject: Re: Toe Gallows
> >>
> >>Maire,
> >>
> >>If you ever get called into court, I would be more than happy to testify
> >>that here in the States, we put ankle tourniquets on for 2 hours with no
> >>ill effect.  At 1 1/2 hours some patients start to complain of pain.
> >>Every once in a while there is an article that comes out that says that
> >>mid high tourniquets are safer than ankle tourniquets. But they fade and
> >>years later they are back again.
> >>
> >>Sincerely,
> >>
> >>Stanley
> >>
> >>At 01:27 PM 12/7/04 +0000, you wrote:
> >>>I don't know if it's local convention/ historically based.
> >>>It would be interesting to know if there have been any studies on this.
> >>>
> >>>Maire Murphy
> >>><mailto:[log in to unmask]>[log in to unmask]
> >>>
> >>>----- Original Message -----
> >>>From: <mailto:[log in to unmask]>T. Mueller, DPM
> >>>To: <mailto:[log in to unmask]>[log in to unmask]
> >>>Sent: Tuesday, December 07, 2004 1:10 PM
> >>>Subject: Re: Toe Gallows
> >>>
> >>>
> >>><<An interesting query;   I received an e mail last week
> >>>from a Dominatrix who has started to use a "Toe Gallows" on her female
> >>>clients. Her concern is re the Health & Safety aspects of using this
> >>> device.
> >>>Apparently the clients ankles are bound together then she attaches
> >>> cotton
> >>>string  around the halluces and suspends them from the ceiling, at head
> >>>level.
> >>>She has been doing this for 20 minutes at a time, the aim being to
> >>> restrict
> >>>blood
> >>>flow until the toes become cold and purple in colour.
> >>>I advised her that 10 minutes would be more appropriate ( based on nail
> >>>surgery
> >>>maximum tourniquet times) but said I would put this message to the
> >>> mailbase
> >>>  for your thoughts.
> >>>This is a genuine question.>>
> >>>In a message dated 12/7/2004 2:51:57 AM Central Standard Time,
> >>>[log in to unmask] writes:
> >>>Kevin & Ralph,
> >>>I understand what you're saying but is it for us to judge? I believe her
> >>>question to have been a genuine concern.
> >>>We may not condone her practices but that won't stop her pursuing them.
> >>>Maire
> >>>
> >>>Not only that, but she asked for guidance. Not giving her any isn't
> >>> going
> >>>to help matters.
> >>>
> >>>But, I'd never heard that there was a ten minute limit on digital
> >>>tourniquets. What is that based on, if other than local convention? (We
> >>>often use tourniquets on the lower extremity for much longer than that.)
> >>>Terrance J. Mueller, DPM
> >>>St. Louis, Missouri
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