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dear all,
60 years old patient with bilateral plantar heel ulcer over a period of 2 years duration. both plantar heel ulcer round in shape and measures 4 cm in diameter with 2 cm depth.active discharge present. patient has been on regular dressing for long time but no response. i would like expert opinion regarding management of this patient

suresh

 

Re: bil heel ulcers

Suresh,
you need imaging (plain film and/or CT) to rule out bone involement.
Is the patient ambulatory? What is footwear like? What other eitiologies are involved? Diabetes, PVD, infection etc. May need revascularisation, debridement (conservative or surgical), off loading etc.

What dressings have been used in the past? We tend to use either cadaximer iodine or silver based dressings on the stage 3-4 heel pressure ulcers that we encounter

 

Hi Suresh,

I am assuming patient is diabetic? I have used PRAFO (pressure relief ankle foot orthoses) with patients with ulcerated heels previously with some success. These are primarily for night time usage but can also be used during the day. I have also used the aircast boot but you need to be careful with compliance as it can be a bit difficult to don. Is the patient amblulant, if so what footwear is he wearing. Is he on crutches?

Declan