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Non-healing posterial heel ulcer

Discussion in 'Introductions' started by st403, Apr 13, 2010.

  1. st403

    st403 Member


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    Hello,

    Can anybody help me... I have a patient who is perfectly healthy, (not diabetic or has any circ problems), he has an ulcer on the posterior of his heel that refuses to heal fully. He developed this as a result of his calliper. He comes to me each week and the wound is approx the size of a 5p, with spongy, macerated callus at the centre. I am offloading each time with SCF and dressing with inadine, but the wound doesn't change. Any help or idea please....

    Thanks to anyone who replies

    :bash:
     
  2. Graham

    Graham RIP

    MIght want to try a heel relief gutter for the bed. This will relieve pressure at night.
     
  3. st403

    st403 Member

    Thanks... the patient is very mobile, quite young and keeps the deflective padding on until we see him, so wouldn't this offer the pressure relief?

    I debride the macerated callus each time, in the hope this will help to heal, but so far, the wound is very much static.

    Once again, I am very grateful to any replies...
    :craig:
     
  4. Ella Hurrell

    Ella Hurrell Active Member

    Has it been swabbed for infection?
     
  5. st403

    st403 Member

    No it hasn't. I think because the wound itself, while is still probing slightly, shows no sign of infection. There has never been any exudate / erythema etc. It just has that small area of spongy macerated callus at the centre. However, I will do a swab this week just to be sure.

    :boohoo:
     
  6. Griff

    Griff Moderator

    Why do you think this ulcer is refusing to heal in a young healthy patient? Is he neuropathic?
     
  7. st403

    st403 Member

    yes he is neuropathic. He had an RTA years ago and subsequently had damage to the leg. I know this will have an impact on his healing, but it has been a while now and I was perhaps wondering if anyone had any idea regarding dressings I could use or suggestions that I haven't thought of..

    grateful for the help, as always :good:
     
  8. Ella Hurrell

    Ella Hurrell Active Member

    Perhaps the design of the AFO can be altered?
     
  9. Griff

    Griff Moderator

    The main impact neuropathy will have on his healing it that he won't stop walking about on it (hence the bit of your quote I put in bold in my last post). If he is young and fit with good vascular status/tissue perfusion and it isn't healing (and its not infected) then it isn't being off-loaded sufficiently.

    Dressings aren't what heal neuropathic ulcerations. You can put anything you want on a neuropathic ulcer - except the patient.
     
  10. Graham

    Graham RIP

    You need total non contact especially at night for heels. Simple deflective padding will not achieve this.
     
  11. st403

    st403 Member

    thanks all. I have been using 14mm of SCF, but I can see this isn't sufficient. I may try 21mm and alter the shape somewhat. Having never before used (or seen) a heel relief gutter, where would I get one from?
     
  12. Graham

    Graham RIP

    I make mine from 6" seating foam from a custom wheel chair seating friend. ^' deep - 8" wide and 12" long cut a gutter in it (half circle) the full length with a band saw the full length - cove with 2' memory foam. Cover with a pillow case and lay the calf in the gutter with the heel over the edge.

    I'm sure a local orthopaedic supply store may have something similar.
     
  13. Ella Hurrell

    Ella Hurrell Active Member

    or, for a simple trial, you could get him to put a pillow under his calf at night, so the heel is offloaded and see if this makes a difference before designing anything more permanent?
     
  14. st403

    st403 Member

    thanks, I think I'll try the pillow thing first... Working in the NHS doesn't give me much scope to 'make things'.

    :craig:
     
  15. axel

    axel Welcome New Poster

    Dear ST403
    Wound are potentially the most difficult and also the most rewarding work. I agree with Ian "Dressings aren't what heal neuropathic ulcerations. You can put anything you want on a neuropathic ulcer - except the patient."
    Do you have access to total contact cast or removable cast walkers that can be padded to reduce pressure and sheer.
    If macceration is the issue it needs to be addressed with dressing type, frequency and reduction of activity.
    Most important - diagnose the original etiology of the wound, confirm vascularity, control wound environment and offload.
    Hope that helps.
     
  16. st403

    st403 Member

    thanks axel... I am currently looking into obtaining a prafo boot, so hopefully that will help.
     
  17. Graham

    Graham RIP

    Where are you in the UK?
     
  18. st403

    st403 Member

    South East... not sure if I want to divulge the exact location, as would give away my anonymity! :dizzy:

    Is there a particular reason you wish to know??
     
  19. JB1973

    JB1973 Active Member

    Working in the NHS doesn't give me much scope to 'make things'

    st 403, do you not have any colleagues who could help you out and maybe have a look and give you a 2nd opinion? no diabetic specialist pods or tissue viability nurse or anything.
    there are a few drawbacks working in the NHS but one of the plus points is the huge support network. there is always someone who can help out. at least thats my experience.
    cheers
    JB
     
  20. st403

    st403 Member

    Yes I do, unfortunately, with the current financial situation we are all swamped with too much work... However, I will be chatting to them ASAP. Armed with all the useful tips I have gained from here though, I have many new things to try. :bash:
     
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