reply summary Bilateral Heel Ulcers, part 3
Ted A. Trower
Description
Collection
Title:
reply summary Bilateral Heel Ulcers, part 3
Creator:
Ted A. Trower
Date:
7/11/2000
Text:
-------------------------------------------------------------------------------
Ted
Have you considered a Centec pressure relief shoe or boot with
a thin plastazote top cover? This might be a cost affective choice.
Steve Prock CPO
-------------------------------------------------------------------------------
Sounds like a toughie. The only thing I've had a few clients benefit from
(i.e.: those that could afford and/or had access to) was hyperbaric O2. I
had a gentleman not too long ago with ~ 3 inch dia ulcer. After hyperbaric
O2, unweighting and proper wound care he is ambulating. Everyone involved
was impressed. If it's available to you, it may be an avenue to follow.
Good luck.
Cameron Renwick, C.O.(c)
Algonquin Orthopaedics
-------------------------------------------------------------------------------
Dear Ted,
I am an Orthotist in the UK and I am involved quite heavily
in the care of patients with Diabetes. In fact I was instrumental in setting
up a dedicated Diabetic Foot Clinic where we as a team (the team comprising
of Diabetologist, Podiatrist, Vascular Surgeon Specialist Diabetic Nurses
and of course the Orthotist) regularly see patients. In a case such as yours
have you considered using Scotch Cast bootees with windows cut out from
around the heel/plantar surface. Also are the ulcers Neuropathic or
Ischaemic ones? If they are neuropathic in origin you stand a very good
chance in healing them, however if they are ischaemic that is another
matter. Also can you tell me the degree of neuropathy present, either from a
neurothesiometer reding or from using the nylon monofilaments. if I can be
of any assistance in this please do not hesitate to get in contact with me.
Many regards,
Ron Ramage
-------------------------------------------------------------------------------
Dear Ted,
Otto Bock have a modular heel relief orthosis that is reasonable in price,
(28F10).
It relieves the plantar surface of the heel via a mid foot arch raise which
is contained in a short sub-orthylene AFO with rocker sole.
Maybe worth a look, there is good TI about it!
Good luck,
Mark Raabe
OrthoSynergy Pty Ltd
(I checked into this one, unfortunately the 28F10 is not available in the
USA - Ted)
-------------------------------------------------------------------------------
You are right on all your observations. However, I wouls ask you to revisit
the bivalve AFO option with this in mind: another study circa 1989 reported
it costs $20,000 to heal one decubitis ulcer. As cost containment, it would
appear more responsible to use bivalve AFOs to reduce that risk. The two
instances I applied them, the heels returned to normal soon after
application. Given volume and circulation concerns just superior to the
ankle, the achilles area could not be modified to unload ther heel while
recumbent. So I over modified the posterior and inferior-posterior of the
heel to relieve the heel. Crepe soles and wedges were used as walking
surfaces. I am personally familiar with your experience and your willingness
to help O& P so I know you have considered many options. Best success.
Tony Denson CO
-------------------------------------------------------------------------------
I am a PT who treats patients like the one you mention with total contact
casts. It sounds as though he would be very challenging due to having
bilateral ulcers and the nursing home status. This can work, however, if
the patient is willing and someone who is well trained in casting is
available. The casts will weight relieve the ulcers and should quickly
reduce limb edema, which may also facilitate healing.
I believe the edema and potential fluctuating volume of the limb will make
any custom AFO device challenging as well. If one foot is more involved
than the other, we sometimes use one TCC on one side with an unna boot or
like dressing on the opposite side to control edema and facilitate healing
while the worst heel ulcer is healing. Then, one the first is healed, he can
be fit with the appropriate orthoses while the other ulcer is treated in the
total contact cast.
Hope this helps,
Kelly Short, PT
-------------------------------------------------------------------------------
As for the end result, once the Nursing home learned the cost they would be
responsible for they determined that restricting the patient to
non-weightbearing bedrest would be much more economical than allowing him to
ambulate in orthoses.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, MI, USA
Ted
Have you considered a Centec pressure relief shoe or boot with
a thin plastazote top cover? This might be a cost affective choice.
Steve Prock CPO
-------------------------------------------------------------------------------
Sounds like a toughie. The only thing I've had a few clients benefit from
(i.e.: those that could afford and/or had access to) was hyperbaric O2. I
had a gentleman not too long ago with ~ 3 inch dia ulcer. After hyperbaric
O2, unweighting and proper wound care he is ambulating. Everyone involved
was impressed. If it's available to you, it may be an avenue to follow.
Good luck.
Cameron Renwick, C.O.(c)
Algonquin Orthopaedics
-------------------------------------------------------------------------------
Dear Ted,
I am an Orthotist in the UK and I am involved quite heavily
in the care of patients with Diabetes. In fact I was instrumental in setting
up a dedicated Diabetic Foot Clinic where we as a team (the team comprising
of Diabetologist, Podiatrist, Vascular Surgeon Specialist Diabetic Nurses
and of course the Orthotist) regularly see patients. In a case such as yours
have you considered using Scotch Cast bootees with windows cut out from
around the heel/plantar surface. Also are the ulcers Neuropathic or
Ischaemic ones? If they are neuropathic in origin you stand a very good
chance in healing them, however if they are ischaemic that is another
matter. Also can you tell me the degree of neuropathy present, either from a
neurothesiometer reding or from using the nylon monofilaments. if I can be
of any assistance in this please do not hesitate to get in contact with me.
Many regards,
Ron Ramage
-------------------------------------------------------------------------------
Dear Ted,
Otto Bock have a modular heel relief orthosis that is reasonable in price,
(28F10).
It relieves the plantar surface of the heel via a mid foot arch raise which
is contained in a short sub-orthylene AFO with rocker sole.
Maybe worth a look, there is good TI about it!
Good luck,
Mark Raabe
OrthoSynergy Pty Ltd
(I checked into this one, unfortunately the 28F10 is not available in the
USA - Ted)
-------------------------------------------------------------------------------
You are right on all your observations. However, I wouls ask you to revisit
the bivalve AFO option with this in mind: another study circa 1989 reported
it costs $20,000 to heal one decubitis ulcer. As cost containment, it would
appear more responsible to use bivalve AFOs to reduce that risk. The two
instances I applied them, the heels returned to normal soon after
application. Given volume and circulation concerns just superior to the
ankle, the achilles area could not be modified to unload ther heel while
recumbent. So I over modified the posterior and inferior-posterior of the
heel to relieve the heel. Crepe soles and wedges were used as walking
surfaces. I am personally familiar with your experience and your willingness
to help O& P so I know you have considered many options. Best success.
Tony Denson CO
-------------------------------------------------------------------------------
I am a PT who treats patients like the one you mention with total contact
casts. It sounds as though he would be very challenging due to having
bilateral ulcers and the nursing home status. This can work, however, if
the patient is willing and someone who is well trained in casting is
available. The casts will weight relieve the ulcers and should quickly
reduce limb edema, which may also facilitate healing.
I believe the edema and potential fluctuating volume of the limb will make
any custom AFO device challenging as well. If one foot is more involved
than the other, we sometimes use one TCC on one side with an unna boot or
like dressing on the opposite side to control edema and facilitate healing
while the worst heel ulcer is healing. Then, one the first is healed, he can
be fit with the appropriate orthoses while the other ulcer is treated in the
total contact cast.
Hope this helps,
Kelly Short, PT
-------------------------------------------------------------------------------
As for the end result, once the Nursing home learned the cost they would be
responsible for they determined that restricting the patient to
non-weightbearing bedrest would be much more economical than allowing him to
ambulate in orthoses.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, MI, USA
Citation
Ted A. Trower, “reply summary Bilateral Heel Ulcers, part 3,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/214666.
