|
Why Is There Is A Chronic Wound On The Dorsum Of The Foot? A Little Detective Work!
By Jay
Lieberman, DPM A 25-year-old female presented to our clinic with a grade II ulceration along the dorsal lateral aspect of her right foot. The patient was referred to us from a residential developmental center. The wound care nurses at the center treat ongoing wounds meticulously and have implemented creative protocols aimed at preventing wounds from developing. The team at the residential center believed that the wound on this patient developed because of a self-inflicted bite.
Initial culture reports indicated heavy growth of methicillin resistant Vancomycin susceptible staphylococcus aureus. The patient received IV Vancomycin during a two-week inpatient hospitalization to treat the infection. A debridement of the wound was performed in the Operating Room. She was treated with autogenous growth factor. The wound healed completely over the subsequent three to four month period only to recur two months later. The patient�s medical history includes hydrocephalus with shunt, mental retardation, spina bifida (surgical repair shortly after birth), seizure disorder, neurogenic bladder, and self-inflicted head lacerations related to head banging. Medications
Allergies � No known allergies Mobility � Self propels in wheelchair and crawls The patient does not speak, but has limited communication capability with signing. When the patient was sent to us for re-evaluation, a complete work up was performed. Cultures and biopsy were unremarkable. MRI was negative for abscess or osteomyelitis. Cerotec bone scan was negative other than generalized hyperemia in and about the wound site. Blood work including pre albumin was essentially within normal limits. She is not insensate and responds to noxious stimuli of the lower extremity. Because of her self-inflicted head wounds, the patient was fitted with a football style helmet. The facemask component prevented biting. Ultimately, it was discovered that her playtime �crawling� was the causative factor of the dorsal foot wound. Like an infant, her crawling involved propulsion off the dorsum of her foot.
While resting, she would sit in a yoga type position, again placing weight on the dorsum of the foot. We brought the patient back to the operating room. A pedicle flap was used to close the wound.
A Crow Boot was fashioned to allow for crawling while preventing injury to the former wound site.
A great source for orthotics and prosthetics is the Hangar Orthopedic Group. James Edward Hangar, one of the first amputees of the Civil War, founded the company in 1861. Today, Hangar is in the forefront of prosthetic technology.
The Hangar COMPLETE SYSTEM starts with the ComfortFlex� Socket System. The most important part of any prosthesis is the fit of the socket. ComfortFlex is a highly contoured, flexible socket that features anatomically designed channels and grooves to accommodate various muscle, bone, tendon, vascular and nerve areas. Today, many amputees are able to run, jump, dance, and participate in sports and recreational activities that were previously thought to be beyond their reach. Many are also able to return to the work force wearing more comfortable and better fitting prosthesis up to 10-11 hours a day. The ComfortFlex� Socket is commonly combined with the Otto Bock C-Leg�, a microprocessor controlled hydraulic knee with swing and stance phase control. To allow patients to achieve their highest level of independence, Hangar offers a high performance foot from Springlite. The Springlite Advantage DP foot incorporates a flexible pylon, which allows 160 of motion. A urethane web positioned at the heel provides shock absorption and allows a smooth transition to midstance and toe-off. Another option is the LuXon� Max. The sole of the LuXon� Max
separates the smooth impact heel from the forefoot allowing for
independent motion of the heel and toe. The contours of the forefoot
allow for a stable side-to-side flexion, further enhancing the
smooth motion of the foot. It also adds stability for walking on
various types of surfaces. |
