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Netizens

Interesting read

Location Of Plantar Ulcerations In Diabetic Patients Referred To A Department Of Veterans Affairs Podiatry Clinic Diabetes News 12 Oct 2006

http://www.vard.org/jour/06/43/4/pdf/perell.pdf

Cameron

 

Interesting information particularly as Sue Barnett presented a paper at the Diabetic Foot Conference last week showing that in some pressure off loading devices you can actually increase pressure on the heel.

We need to make careful decisions on how we reduce pressure to aid the healing of all ulceration in this high risk group of patients. Again we come back to assessment as being most important in deciding treatment modalities.

 

Such as?

 

It was a great read.We do not think of heel ulcers too much.I went to the Mt.Sinai conference for the Geriatric Foot and Ankle this weekend.One of the lecturers said that we can and should debride heel ulcers.I usually do not do this,in fact,that statement ran counter to what most of us do.Does anyone have any thoughts on this topic?

 

John,

Best practice guidelines recomend leaving an intact heel pressure ulcer blister in place, but possibly aspirating a small amount of fluid, but fully debriding using either surgical or conservative sharp debridement or mechanical methods an open pressure wound

The Queensland dept of Health produced a Pressure Ulcer Prevention and Management Resource Guide in 2004 that is pretty comprehensive.

There is also some info about prevelance in Victorian Hospitals at http://www.health.vic.gov.au/pressureulcers/

 

That seems about right.I am not a fan of extensive debridement of these heel ulcers as I find that they respond to topical care and better avoidance and protection of pressure points.Better padding in wheelchairs and changing positions in bed plus good nutrition(and for a lot of my patients,what they eat and drink tends to exacerbate these ulcers..their albumin/protein values are poor) equals a good result.