Mechanical control

Patients with extensive cellulitis should not walk. They should be on bed rest and use crutches, Zimmer frame or wheelchair for trips to the bathroom. Every step taken will spread infection.

Heels must be protected with a pillow/foam wedge under the calves to keep the patient's heels clear of the mattress when he is in bed. Special mattresses should be provided to prevent decubitus ulcers. If he slides down the bed he risks pressure lesions from the bed end.

Long periods on the operating table can lead to heel blistering and heel necrosis, and patients who go to theatre should have their heels regularly protected.

We sometimes off-load postoperative wounds in the neuropathic foot with a removable bivalved cast or windowed cast which enable wound inspection.

After operative debridement in the neuroischaemic foot, non-weightbearing is advised until the wound is healed. Patients with infected neuroischaemic feet may wear a 'Scotchcast' boot in bed to protect the heel.

Pressure-relieving ankle-foot orthoses (PRAFOs) are helpful heel off-loaders in both classes of foot.

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