How will decompression in the ulcer area be performed

Bed confinement and use of a special wheelchair for moving around are very effective measures, but patient compliance can be difficult. For this reason, measures that permit some restricted mobility are applicable. The use of a cane, and support of the foot on the heel when there is no ulceration, are also effective.

Table 17.2. Guidelines for the individuals that are in danger of developing ulcers in their feet

Individuals that are at increased risk of developing ulcers should:

1. Look at their feet daily (dorsum, sole, regions between the toes). Inspection of the soles can be performed by another person or with the use of a mirror. When sight is poor, inspection should be performed by another individual.

2. Avoid walking barefoot (without shoes or slippers), even inside the house.

3. Never wear shoes without socks, even for small intervals.

4. Buy the right size of shoes. Iindividuals with neuropathy get used to buying footwear of smaller size, so that they press their feet a lot.

5. Not wear new shoes for more than one hour per day. After taking off the shoes, they should inspect their feet carefully.

6. Change their shoes once a day (in midday) and if possible in the afternoon as well. With the change of shoes, unloading of certain regions of the foot is achieved.

7. Feel inside their shoes for presence of foreign bodies before they wear them.

8. Wash their feet daily and dry them carefully. Particular care (cleanness and dryness) is required for the regions between the toes.

9. Not put their feet on or very close to thermal bodies.

10. Check the temperature of water in the bathroom with the elbow of their arm.

11. Not try to remove hyperkeratosis of the feet on their own, using sharp tools or various chemical dressings. Removal should be performed by a physician or trained podiatrist.

12. Cut the nails straight (not in the sides of nails).

13. Wear the socks with the seams outside or better wear socks with no seams.

14. Not use footwear in which the interior is worn out.

15. Use special ointments for hydration of the skin (these are applied only in the plantar and dorsal surface of the foot, never between the toes, because the risk of infections and superficial ulcerations is increased with the increase of humidity).

16. Check their feet carefully for presence of minute trauma after walking for a long time.

17. Ask for medical help immediately when there is pain, trauma, even shallow, oedema, redness or black regions in the feet.

There are special therapeutic shoes available for decompression of the front or hind part of the foot (half shoes). These are worn until complete healing of the ulcer. Furthermore, specially-designed shoes and soles that reallocate the pressures in the sole, decompressing the ulcer area, are also helpful. Existing studies have shown, however, that people with ulcers very frequently prefer their usual shoes and not the special shoes in daily activity. Sometimes the duration of usual shoe use is almost double that of the therapeutic ones, despite the fact that the patients report using the therapeutic shoes during most of their activities.

The most effective way to decompress the ulcer area is the application of a total contact cast with a proper base so that restricted walking is permitted (method of choice). It has the disadvantage, however, that it is not appropriate for infected ulcers, when frequent inspection and bandage change is needed, or for heel ulcers or when peripheral vascular disease exists. The cast should be changed every 1-2 weeks. A hole under the surface of the ulcer permits its frequent inspection and bandage changes. Another effective decompression method (maybe equally effective as the application of a cast) is the application of a removable cast (instant total-contact-cast). To increase patient compliance, a band of plaster or a strong adhesive band is wrapped around the cast at the height of the calf, so that its removal is difficult. Other decompression methods include special boots (Scotchcast and aircast boots) that are removable and suitable for infected ulcers or with lots of exudates, although their effectiveness is not proven.

0 0

Post a comment