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Is this a pressure sore?

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  • Is this a pressure sore?

    I noticed this spot on my right heel yesterday as I was getting out of the tub.

    It's a bit smaller than a U.S. quarter, and it feels hard to the touch, like a callous. It's probably from lying in bed with this heel pressing down onto the mattress.

    One potential complication is that I'm currently dealing with a massive DVT in this leg, running from below my knee all the way up to my filter. I'm on Lovenox and coumadin. I'm pretty sure this sore was here before I started taking these meds, but might they affect how this sore heals?
    Last edited by Lazlo; 03-30-2009, 04:01 PM.

  • #2
    Yes, that is a classic deep tissue injury pressure ulcer of the heel. You need to keep all pressure off your heel, no shoes (get some boots you can wear in both bed and wheelchair that prevent any heel pressure). An area like this, if you are very lucky, and comply with the above, will gradually resolve over about 6-8 weeks and will peel off on its own.

    No need for a dressing or any ointment (which won't help at all). Press lightly on it daily to assess. If it gets "boggy" or pus starts to come out the edges, or you get a lot of redness around it, you need to see your physician. Don't let it be debrided otherwise.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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    • #3
      KLD,

      I have always been somewhat confused about deep pressure injuries. Are they basically bruises? That, as with a typical pressure sore, won't heal properly w/ continues pressure?

      Shoot Zero! It seems you can;t get a break can you. SO how is the pump doing? (As if you could even tell, what with the DVT, UTIs and now this!)
      T7-8 since Feb 2005

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      • #4
        A DTI is a type of pressure ulcer. It is not a bruise, but bruises, with pressure can turn into DTIs. This picture above is a DTI, not a bruise.

        (KLD)
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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        • #5
          Well I had a scheduled visit with my SCI doc today and showed him the spot. He said the same thing: keep all pressure off it and watch it closely, hope that it doesn't open up, and otherwise don't mess with it. I still have the prafo boots from when I was in rehab so I'll probably start wearing them again at least at night.

          Sjean, you're right I can't get a break! The pump is up to 700mcg/day and still no noticeable improvement. I do think the spasticity is at least part of the cause of the sore since my legs curl up when I'm sleeping causing my heels to dig down into the mattress. I just had my first refill today. I hope this thing kicks in soon because I could really use at least a little relief.

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          • #6
            I had something similar back in November except mine was more of a water blister (big bubble). I wore shoes with no backs & kept it elevated as much as possible and it healed up fine(like 2 months). Once it was flat I kept a loose bandaid on it just to keep from anything like socks or whatever rubbing it.
            Life is like a box of chocolates, you never know what you're gonna get.

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            • #7
              zero, is your heel swollen as well? it's hard to tell from the pic. right away it looked like christopher's elbow to me when he had staph.
              Never take life seriously, nobody gets out alive anyway

              Frank's blog:
              http://www.franktalk-scurry.blogspot.com
              My regular blog:
              http://www.ithinkithinktoomuchblog.blogspot.com

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              • #8
                Chad has had those too .... sorry to see you have one too.
                Wife of Chad (C4/5 since 1988), mom of a great teenager

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                • #9
                  Originally posted by Zero View Post

                  Sjean, you're right I can't get a break! The pump is up to 700mcg/day and still no noticeable improvement. I do think the spasticity is at least part of the cause of the sore since my legs curl up when I'm sleeping causing my heels to dig down into the mattress. I just had my first refill today. I hope this thing kicks in soon because I could really use at least a little relief.
                  I have to watch that myself, even with the pump. Mine do the same thing, and sometrimes I will wake up with a red spot, so far nothing worse, but I am careful to check every morning.

                  Glad they are still tweaking the pump. Hoping they find the right settings. Of course, once everything else clears up, you are probably going to be a bunch of spaghetti that needed only 450 mcgs!
                  T7-8 since Feb 2005

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                  • #10
                    "I'll probably" start wearing them...... NO absolutely you need to wear the PRAFOs, or the pressure will remain and not only won't it heal, it will get worse. So please even as inconvenient as they may be- it will go away. But if you don't it will surely get worse, or could look the same on the outside and suddenly explode into a huge wound from the inside out, and being so close to the calcaneous could put you at risk for osteomyelitis. Don't mean to scare you- I just see it all the time in clinic. An ounce of prevention..... well you know the rest. Please take care, Pam OTR/L

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                    • #11
                      I hate the PRAFOs but I agree, it's so hard to keep pressure off of it otherwise.

                      Cali, It's not swollen or raised at all, but it feels hard if I press on it.

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                      • #12
                        There are different kinds out there. We use a couple 1) L'Nard splints, and then we also use a Roylan product that is like a big blue muckluc sp.. I don't doubt they suck to wear - warm, limit you ability to Ily move.

                        I know many skin specialists would advise against this but I have had patients who don't have the money to buy splints or PRAFOs so they place their calfs up on a stack of pillows while laying face up on their bed so that the heels are COMPLETELY free (by several inches) of pressure from the bed. Not ideal but better than nothing. You just need to make sure and stretch well in the morning so that you don;t lose ankle, knee and hip range of motion.
                        Again last resort but better than the alternative. I am sure SCI Nurse would concur that this is not ideal for a variety of reasons, but again float the heels to relieve the pressure.

                        Take Care, Pam OTR/L

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                        • #13
                          Placing the heels on a stack of pillows is not ideal for all the reasons stated above, but it is a way to keep the pressure off of the heels. If you really can't stand the PRAFO's or can't stand them all the time, try floating the heels. It might be a little more tolerable.

                          Please watch it carefully and if any of the symptoms that KLD spoke about appear- get yourself to your doc as fast as you can!

                          CKF
                          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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                          • #14
                            Don't mean to hijack your thread but I have something that looks very similar to this but thought it was a callous now after seeing your picture starting to have different thoughts. I don't have prafo or whatever it was called so what would be the best thing for me to use at night to keep pressure off the area. What about those fake sheepskin protectors? I have tried sleeping with a pillow under my ankle but end up moving during the night and wake to find my foot laying flat. My callous/sore is more to the side of the heel and is not mushy or swollen. I have only had one pressure sore and that was 37 years ago when I was first injured (T-8 para) and in the hospital (they didn't bother to turn me) so I really don't know how to care for one.
                            A fanatic is one who can't change his mind and won't change the subject. ~Winston Churchill

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                            • #15
                              You can try to use the fake sheepskin protectors, but make sure that you elevate that heel off of the bed- Can you lay prone so that the heels don't touch the mattress? Also, make sure that you don't wear shoes especially if your feet swell. If you have any spasticity, make sure that the feet don't rub against anything including the heel protectors on your wheelchair.

                              CKF
                              The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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