Heel ulcers / Australia

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Hi colleagues, requiring some assistance. Elderly gent with large heel ulers. R/F is located plantar, lateral. Received these in hosp. Has had RDNS using solosite for some time with recent felt padding. He has had vasc surgery to left leg. Smaller plantar ulce, unaddressed ulcer on distal 2nd to 1st mpj 1 dorsum and one leg. His skin integrity is compromised so we need to move away from felt stuck to skin.
The assistance I require is not with wound dressings and management BUT with pressure relief.
Sometime back I say a a cam walker type device? with posterior heel relief Several pods have not been able to find this but believe it exists? Are we imagining this or is it real?!
Then we can create create padding/insole to relieve the w/b pressure both plantar and post hee!? . This would need to do up without trauma to dorsum or shin?
Non w/b thinking foam wraps for bed dense and thick enough with bevelled edges and cut to size? to allow pressure relief as he rolls and sleeps on his side! Appreciate your ideas and assistance, kind regards Heather

 

How active is the gentleman, do you need to off load him in bed or whilst walking? or both. In our clinic we have offloaded both areas with a diabetic aircast with the innersole modified so that he doesnt take weight on the heel, orthotists have made patellar braces which have assisted in off loading the heel. Cradle walkers also throw the COP forward, reducing some heel pressure. We have not yet had any problems with the aircast creating pressure on the anterior aspect of the leg and we have had some patients with very fragile skin and compromised circulation. When it comes to relieving pressure in bed we would probably go for one of those fluctuating air matresses or sponge boots, with regular changing of his position.

I hope this is of some help

Best wishes

Helen

 

When in bed, best option to relieve pressure from a heel is a foam bed wedge, so the heel has no pressure on it. Air mattresses do not always relieve pressure adequately from a heel. For ambulating there are a number of commercially available heel pressure relieving devices. Cam walkers can often be a problem in the frail elderly with balance and mobilization. We would tend to modify a post op boot (we use a reboot from Walkon) then add foam, felt etc as required.

You can also try opsite, then sticking on the felt.

Also not a big fan of hydrogels on these wounds as they tend to macerate and take for ever to soften the eschar. Better using sharp debridement with pain relief if required to remove eschar then follow up with cadaximer Iodine and a foam.

 

Thanks Helen this gentleman needs off loading whilst walking and in bed. Appreciate your assistance.
Hi Stephen, how does a foam wedge work when the patient is moving around during the night? I do not know the reboot? Do you have a website I can access information on this device? Appreciate your assistance as well kind regards Heather

 

Walkon have a website http://www.walkonfootwear.com/home.htm but the reboot isn't on it! they are a robust postop type shoe at A$55, so not cheap compared to a Darco shoe at A$25, but last much longer.

The foam wedge is the width of the bed, and is placed so that the heel hangs over the edge. They work better than the gutter pillows, which patients will often roll off.

 

Thanks again Stephen, so where does one get foam wedges? Are they cut to size? Is there a specific density? Is there a number of degrees for wedge? Does it go from knee to ankle? No doubt this is all basic stuff too you but not having used this before I need help with specifics. Appreciate you time and expertise, kind regards Heather

 

Clark rubber sell them as well as a host of medical supply companies, they cost between $80 and $150 dollars and have a wipe clean top. Google "bed wedges" and you should find a few (most of them I found here were used under the head, but just turn them around)

 

Again thanks for your help. Have been able to source a foam boot for bed that alleviates all pressure, thus allowing patient to roll onto his side and move around! Will follow up other info supplied again thanks cheers h

 

Hi,

I have found the aircast devices (with modified internal pz insoles) to be of use in this situation. Compliance needs to be checked though. I would also look to use a PRAFO for night time, google (or blackle now!!) Multi Podus Foot Orthoses made by Restorative care of America.

Declan

 

Pt presented with total vaascular compromise sent him off in ambulance, he has had 2 vascular surgeries and 1 toe amputation and is still in hospital but wife keeps in contact to let us know all is well. thanks for your knowledge and assistance. kind regards
Heather