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    wound on heel is taking a long time to heal

    hi everyone I'm new at writting in....I read posts almost every night and you guys have great responses....here it is....my son(22 yrs old) is a walking para(L-2) injured on 09 -10-2004 he has been walking using a cane since march...he does not have feeling in his feet,buttocks,back of legs...he went to the beach with some friends 6 weeks ago and when he came out of the water almost half of his heel was sliced off by something in the water.he went to the DR. and he was given an antibotic cream and he has been great with keeeping it clean and bandaged, the problem is when he walks he walks on his heels ,flat foot(no heal-toe movement) the wound is now about the size of a half dollar but still about 3or 4 layers deep,it still oozes ...my question is.. could this become a pressure sore? he lets it "air dry" over night and most of the day,but he won't stay off it at night(he is a night owl) he puts several layres of bandages on before he puts his shoes on,being a mom I'm always overly concerned...he says he can't get pressure sores...what do you think....thanks for the imput...anything to ease my mind or bug him to go back to the DR.

    #2
    If it's three or four layers deep and he's drying it out ... that's the wrong thing to do given current practice and theory in pressure sore healing (which it is). The idea is to keep a wound moist so that the cells may repair and build up (heal) again. I don't like the idea of covering it with a dressing and shoving it back into a shoe either. What dressing is he using? Gauze is the worst thing ...

    Half of his heel to half a dollar size in six weeks isn't bad healing though. Has the healing 'plateaued?' Is the wound left, the part that he walks on and is it close to a bone?

    Does the foot swell? An oozing wound tells me that there's swelling or infection (or it doesn't like the walking) ... if it swells, it won't heal until you deal with that issue first. (Fluid build-up in the foot or leg will escape out the heel wound ensuring it never closes).

    I'm surprised his doctor didn't give him a round of oral antibiotics given that the original wound occurred at the beach - I assume he had to walk back in over sand, dirt, grass etc ... you have to be very careful here as there isn't much 'meat' between the wound and bone. Take it from me, you don't want to deal with osteomyelitis (an infection of the bone) as it can take years - yes I said years - to heal. Several complications to be had as well as a risk of amputation.

    It wouldn't hurt to see an Enterostomal Therapist (someone who specializes in wound healing) just to evaluate it and suggest improvements and tell you he's doing the right thing. Your local hospital should be able to point you in the right direction to see one.

    I'm no nurse or doctor - but have dealt with heal sores for 17 years - this is what happens when you don't take it seriously at first ... I'm also paraplegic but complete - do not walk.

    P.S. A wound is not considered 'chronic' until it is over two years old.
    Last edited by lynnifer; 25 Aug 2005, 4:28 AM.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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      #3
      JustMom

      I am a burst L#1 with initially no feeling from knees down (no heel to toe action here either). Tho I have been doing stretching exercises and that is really helping alot...putting more and more weight on ball and toes every day.

      I got shoe inserts to squeeze the heel making more padding in the heel area, as it was too painful to walk any distance. It felt like I was walking directly on my heel bone. It has really helped but now I have developed a long callous along the heel area and it has cracked open in several places. I too am going to see a enterostomal therapist. Can't seem to put enough lotion on to soften it in the slightest and I've had it for awhile now.

      I'm also taking yarrow, a few drops per day and the numbness is getting lower and lower...I don't know if it's the yarrow and if it is just improving on it's own. But the numbness didn't start going away til I was on the yarrow for a month or so.

      Good Luck to your son, and yep, he should see the doc. If he's like me and your feet hurt, you can really get cranky.

      Queen
      Your life is what you make it, and only you have that choice!

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        #4
        Thanks For The Replies....yes I Think The Healing Seems To Have Plateaued....the Wound That Is Left To Heal In Right In The Middle Of His Heel...it Starts To Scab But When He Takes A Shower (he Stands To Shower) The Scab Comes Off...after He Showers He Cleans It With An Iodine Wash Followed By The Antibiotic Ointment(rx) And Non Stick Gause And A Waterproof Bandaid...there Is No Swelling And No Reddness But It Still Looks Like Raw Muscle.i Try To Get Him To Walk Using Some Crutches But He Said That He Can't Walk Well With Them And He Loses His Balance.....i Feel That Because He Can't Feel Pain He Does'nt Think It Is Serious....thanks Again For The Input

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          #5
          I don't know who told him he could not get a pressure ulcer, but this is not correct. Anyplace that a person lacks sensation is at risk for development of pressure ulcers. A traumatic injury such as this can easily turn into a pressure ulcer. I have seen a number of foot pressure ulcers in people with lumbar and sacral injuries, some so severe that amputation was required due to heel osteomyelitis. Circulation is not as good in the feet, so healing may take longer and be more difficult, and the skin is thin over most of the foot, making osteomyelitis a real risk with most foot wound.

          Iodine and iodine products (like Betadine) are bad for wounds as they kill the fibroblasts that are trying to heal the wound. The same is true for peroxide. The wound must be kept moist. A hydrogel would probably be a better wound care product, but I would have to see the wound to advise further.

          I would suggest that he see a wound care specialist (plastic/reconstructive surgeon) or visit a local wound care clinic. He should not be weight bearing on that heel at all now. Continuing to walk on it or wearing a shoe, regardless of using padding inside a shoe, will prevent the wound from heeling, and puts him at risk ultimately of loosing more than he may imagine.

          (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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            #6
            I have to agree with Lynnifer here. Letting the wound dry out is a mistake if it is a pressure sore and if it isn't, well, no harm done in letting it heal from the inside out. Correct me if I'm wrong SCI Nurse.

            My hubby uses DuoDerm on any injury of this nature (at the drug store, behind the counter), which you can leave on for up to a week. He had some very serious pressure sores on his toes lately which took 4 months to heal using this product and things were iffy at best for a while, but eventually they did heal. Please take SCI Nurse's suggestion and see a wound care specialist. Pressure sores are nothing to mess with, one killed my Grandma in no time flat. Better safe than sorry.

            Jewel
            Do not live your life in fear of your own government because the moment that you do, is the moment they rule you.

            Me

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              #7
              Thanks for the info...My son read the replies and called his PA at the VA in Agusta and got an appointment on Tuesday....He will not walk on his foot...its crutches or wheelchair...in the meantimewe got a saline type solution to clean the wound and a new type of bandage that he can keep on for a couple of days at a time....Thanks, your input may have saved his foot

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