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Wound Care and Treatment
The basis of treatment regimens for the neuropathic or insensitive lower limb is derived from the work of Dr. Paul Brand. His work demonstrated that plantar ulceration results from a lack of protective sensation coupled with high plantar mechanical forces. With this in mind, the primary healing mechanism of plantar ulceration is offloading of the foot. Applying an appropriate wound dressing or topical is secondary.
| The wound care techniques used with the Hansen's disease population are directly applicable to other diagnoses such as diabetes, Spina Bifida and other diseases or injuries causing lower extremity neuropathy or peripheral neuropathy. |
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If the TCC and PWS are not appropriate, alternative
pressure relieving devices or healing devices
such as the Carville Custom
Sandal, Plastizote boot, prefab healing sandals/shoes
can be fabricated, modified or augmented to offload
the foot. Upon wound closure, permanent footwear
and orthotics are
fitted to prevent reulceration.
Equally critical to Dr. Brand's treatment approach is understanding and addressing the psychological ramifications of neuropathy that make treatment protocol sometimes difficult to follow. Neuropathy, specifically peripheral neuropathy, alters or eliminates a persons body perception, proprioception or touch/pain reception. The limbs no long er respond normally. This is significant because the perception of pain is the leading indicator of body malfunction, a consequence of bodily harm, without which a person can cause damage or continued damage to self with no awareness of injury. The client with a plantar ulcer typically will not walk into the clinic limping or complaining of pain. To compensate for this insensitivity to pain the patient, family members and health professionals have to make an extra effort to manage existing wounds. Visually inspecting and touching the feet daily for any evidence of new trauma or injury are essential habits to develop in an effort to protect the feet from injury. "Pain: The Gift Nobody Wants" is the title of one of Dr. Brand's books and a phrase used to initiate the explanation regarding the devastating consequences that can occur from limbs without the necessary warning system of pain. |
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All options used for the wound healing phase and initial ambulation after wound closure must include use of an assistive device for partial weight bearing (PWB) , preferably crutches or a walker.
Self-examination is critically important for any patient with loss of sensitivity in the foot. |
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