I got a tough referral the other day and could use some ideas.
The gentleman is a nursing home resident (on a part A stay for folks in the
USA) with severe bilateral heel ulcers. The ulcers are on the plantar
surface and cover the entire region of the heel pad plus a little more. He
is a long term diabetic with neuropathy and vascular compromise. The entire
length of the leg below the knee is very edematous. He is also moderatly
obese. He is up in a wheelchair but takes a few steps every time he goes
into the bathroom. He is currently wearing kerlix dressings under slipper
socks. He is too unstable for something like IPOS heel relief shoes. He is
alert but suffers enough encephalopathy that I doubt he would remember or
follow instructions to remain on bed rest. I also doubt the nursing home
has the staff to enforce it.
I’ve looked at the usual PRAFO type devices but do not believe they would be
effective in protecting the plantar surface of the heel when standing. I’m
leaning towards placing him in bilateral healing boots of the total contact
bivalve AFO type but seem to remember reading a study stating they were not
very effective on plantar heel ulcers??????? Also given that he is on a
part A Medicare stay the nursing home will have to pay for them and I’m
expecting strong resistance to the cost. Thirdly I doubt just how stable
this individual would be in attempting to stand and walk with these devices
on both feet. Perhaps it would be one way to enforce bed rest but I
certainly do not want to cause him to fall. I’ve told the nurse and the PT
that my impression is this gentleman would be healthier and more functional
with bilateral BK amputations but no one is ready to hear that yet.
I’m open for suggestions, will post a summary to the list in a few days.
Thank you in advance.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, MI, USA
