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Fissured heels

Discussion in 'Diabetic Foot & Wound Management' started by Gillian Pennington, Aug 24, 2009.

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    I have been treating a 75 year old male patient with severe vascular impairment to both lower limbs, the right being worse. He has been treated in hospital, and I understand from his family doctor that here are no further surgical options to be explored. He is now a non-smoker. Both dorsalis pedis and tib post pulses are just palpable. Both feet are cold, and dusky pink. He is now at home, and is hoesebound.
    I have been treating this patient since May.
    He has extensive vertical fissures on both heels, about 7 on the right, 5 on the left. These were not very deep, about 2mm, but all had black dried tissue. I have instructed the use of duoderm hydrocolloid dressings, which have softened the eschew, making it green. The wounds are decreasing in size.
    Question: How do I debride this eschew? It is very soft, and difficult to remove.
    What should I be using next as a dressing?
    What is the likely outcome for this patient?
    Any ideas would be welcome.
  2. Graham

    Graham RIP


    Be carefull with the duoderm. If it makes it too soggy the circulation may not be good enough to deal any potential infection. I would continue with the duoderm as long as this is being checked at least three X week. Ideally he should have heel relief gutters in bed that totally relieve the heels from pressure. Once the fissues have closed I use Bag Balm daily.

    If they deteriorate I switch to 10% povidone iodine.
  3. Thankyou for your reply.
    I will check the heel gutters to improve the painful symptoms at night.
    The right heel has greatly improved using the duoderm, but the patient finds it very painful on the larger surface areas of the wounds of the left heel.
  4. Graham

    Graham RIP


    any chance you can do a toe pressure measurement and/or a dependent rubor test?

    For the heel that is very painful his circulation may not be dealing with the moist wound healing demands o the duoderm. Sometimes these will never heal but you can keep them clean, dry and less sensitive just with povidone iodine and dry gauze.

    You can often make an ischaemic wound worse if the circulation is unable to meet the demands of the moist envireoment. Sometimes keeping it clean and dry is the best option. It may never heal but he will be more comfortable.

    I make my own heel gutters from Firm seating foam with a memory foam cover. If you have a custom seating department, for wheel chairs, near by you could pick up the stuff to do it. I don't find the commercial heel relief products very good.
  5. Thankyou Graham.
    Thanks again for your reply.
    From what you have said I am going to use betadine and dry gauze, and review regularly. There has been some improvement on the right heel, but my patient is having discomfort, so I think the pain stability is more important.
    I appreciate your help.
  6. carolethecatlover

    carolethecatlover Active Member

    I'm just a student, but may I suggest in cold and sun low Canada, you 'prescribe' your patient some vitamin D and A? Both essential to healing. Here in the land of Oz, the Aborigines who move to the cities, wear clothes and work indoors often get slow healing , particularly bruises. They need vit D, (and A, the study I read only studied D, but they work in synergy) The white, usually Pink, people of Oz make enough vit D in their skin everyday, but not the blackfellas! (Not an insult, they call themselves that, and us, whitefellas) In Canada, you could be lacking vit D even if you are white, if housebound.

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