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What’s New in Foot Care?

by Joy Pape, RN, BSN, CDE, WOCN, CFCN

Wound care
If you do develop a wound on your foot, it’s important that it be kept clean and moist to heal. Years ago, it was thought that sores healed best if they were left open to the air to dry out and form a scab. That is not the thinking today. Now experts recommend moist wound healing, which prevents the formation of a scab, to allow a wound to heal from the inside out.

When you apply first aid to a small wound yourself, keep it clean and moist by first washing the area with soap and water, then covering the wound with a bandage. Younger people with healthy skin can often use a regular adhesive strip (such as a Band-Aid) to cover minor wounds. However, older people and those with fragile skin should not apply adhesive directly to the skin. Instead, cover the wound with a sterile, nonstick, gauze pad, use rolled gauze to keep the pad in place, and use tape to affix the end of the rolled gauze to itself, not to your skin.

Larger wounds or any wound that does not start to heal within a day or two should be seen by a health-care professional, possibly one who specializes in wound care. If your wound has already formed a scab when you seek help, your wound-care provider may suggest debriding the wound. Debridement is a technique for removing scabs and dead tissue, resulting in a clean wound.

Never try to debride or remove dead tissue yourself from any wound, especially on your feet. Only a health-care provider who is trained in wound care should perform any form of debridement.

There are four methods of debridement, as follows:
Autolytic. This method employs the body’s own enzymes to liquefy the hardened dead tissue in the wound. Various wound dressings may be used for autolytic debridement.

Mechanical. By moistening a dry dressing such as gauze, applying it to the wound, allowing it to dry, then removing the dry dressing, you also remove some of the dead tissue on the wound. However, this method also removes some healthy tissue and can be painful.

Enzymatic. This method uses a chemical enzyme to speed debridement of dead tissue.

Surgical. The fastest way to remove dead tissue from a wound is for a doctor or other qualified health-care professional to use a scalpel, scissors, or other sharp instrument to cut it away. Most deep wounds need to be surgically debrided, and they may need to be surgically debrided more than once.

There is some disagreement in the medical community about whether all heel wounds should be debrided. If you have a heel wound, therefore, your doctor’s thinking on this matter will influence the treatment he recommends.

When a doctor is surgically debriding a wound, it is not always possible to see the extent of the dead tissue needing removal. There are now devices to help doctors see exactly where to go during the surgery by revealing which tissue still has blood flow (live tissue) and which does not (dead tissue).

According to Dr. Lee C. Rogers, DPM, Associate Medical Director of the Amputation Prevention Center at Valley Presbyterian Hospital in Los Angeles and Chair of the American Diabetes Association’s Professional Foot Care Council, “The SPY Imager from Novadeq is brand-new in the wound-healing arena. It is a novel device that uses a kidney-safe dye that can shows you the blood flow in the skin when looked at with a laser camera. Additional devices that can help doctors assess the blood flow to your limbs are PADnet from BioMedix, and SensiLase from Väsamed.”

Help for healing
In addition to having special techniques for cleaning wounds, doctors have some new tools to help speed the healing of wounds.

TCC-EZ. When you have a wound on your foot, another important aspect of healing is keeping pressure off the wound. This means you should not be putting the weight of your body on the foot that has a wound. In other words, this means no walking until your wound is healed. Since this can take months or even longer, it’s a pretty impossible feat for anyone.

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Daily Foot Care
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