Wound Care: part 1a neuropathic wounds

what are some predisposing factors to wounds

diabetes

SCI

AIDS

peripheral neuropathy

what is a common locations for neuropathic wounds?

plantar surface of foot

what is the common wound base for neuropathic wounds?

deep,

often granulating unless PAD present

impaired sensation

osteomyelitis is a concern

what does a wound edge look like in a common neuropathic wound

well defined

what does a periwound look like in a common neuropathic wound

callous, cellulitis

what are the 3 types of neuropathy changes?

diminished or absent sensation in foot

Xeroxes and anhidrosis

musculoskeletal changes leading to foot deformities

what are some additional foot presentations with neuropathic wounds

subcutaneous fat atrophy

material findings if patient has pad

what is a Charcot foot

A condition characterized by progressive foot deformity due to neuropathy, leading to joint damage and instability.

what are the risk factors for those with DM

loss of protective sensation

PAD

foot deformity

history of foot ulcer

LE amputation

how do we prevent

ID risk

regular inspect and examine the at risk foot

provide structured education for the patient, their family, and healthcare professionals

ensure routine wearing of appropriate footweaer

treat risk factors

what are some prevention interventions at home

daily foot care

see podiatrist

proper footwear when WB

always shoes and socks

no thin slippers

closed toedw

what is some daily foot care tips

titration of new or increases activity

look at and feel foot at end of day (check for cuts, blisters, callouses, cracks)

wash daily

use emollier

cut nails

no heat, cold, chemicals

what should we do as far as wound management in someone with a neuropathic wound?

OFFLOADING:

limit steps

wear appropriate offloading devices whenever WB

use AD

footwear and footwear behavior after closure: properly fitted, protection from trauma and pressure

what are some wound treatments we can do?

sharp debridement of callous, slough, debris, any devitalized tissue

appropriate dressing selected based on exudate

which method is considered a gold standard for offloading for neuropathic wounds

total contact casting

can a non removable knee high walker be removed?

no, help heal better and faster

what are some character a non removable knee high walker

similar results to TCC

forced adherence

lower material and application costs than TCC

faster to apply than TCC

what are some characteristics of removable knee high walker

foam insole with removable pegs

mean peak pressure similar to TCC

patient able to remove

what are the characteristics of removable ankle high off loading device

protective shoe with foam insole

rigid sole limits MP joint extension, dispersing pressure over plantar surface during gait

removable insole pegs may reduce pressure at wound

what devices are best for non plantar wounds?

removable ankle high offloading device

footwear mods

toe spacers

orthoses

when offloading for treatment how should you progress

start with non removable knee offloading device

when wound closes progress to removable offloading device (2-3 weeks)

taper from offloading device to a diabetic shoe