Bully Pulpit: Heal, Heel!

March 1, 2016   Opinion

New Mobility Magazine | Source

Tim GilmerSince writing about my pressure wound battles and having to have my left leg amputated below the knee in August 2012, I’ve heard from many of you who have had similar experiences with persistent pressure wounds. They come and they go, and too often they come again. Just a week ago I discovered a wound on my heel (my only heel), which caught me off guard. I’m still not quite sure what caused it. But I know what I must do to get rid of it.

This wound is serious, not because it is big or deep (it is neither), but because of its location. Foot wounds, particularly heel wounds, are especially dangerous. They are as far away from our heart as a wound can get, so blood supply sufficient for healing may be a problem. They are also most prone to swelling, since they occur at the lowest point on our bodies. And they are often in contact with bathroom floors and harmful bacteria. As if that isn’t enough, the heel has relatively little flesh, so the bone is close to the wound and vulnerable to becoming infected.

So what can we do when a wound suddenly appears in a troublesome area? There are five essential requirements for a wound to heal: freedom from infection; adequate blood supply; no or minimal edema; freedom from pressure; and adequate nutrition, especially protein. If only one of these requirements is missing, the wound will fail to heal or take months or even years to heal.

Staying infection-free may require immediate antibiotic treatment. If you are prone to developing infections, taking a prophylactic antibiotic daily may be best for you. Consult your doctor. But other factors can put you at risk for infection. Edema, for example. As I write this, I’m sitting in my recliner with my foot elevated — one of the most efficient strategies for reducing swelling and speeding healing.

But no matter what you do, healing will not occur with inadequate blood supply. If you suspect this, go immediately to your doctor and ask for an ankle-brachial index to be performed. This will let you know if you need to see a vascular surgeon to discuss options to improve your circulation.

Keeping pressure off the area means just that — zero pressure. You may think a little offloading may do the trick, but nothing is better than zero pressure — even if it means taking to bed (or getting a new, specialized cushion).

The final requirement is eating enough protein to stimulate healing. Quite often, the main reason for non-healing wounds is inadequate protein. If you are doing everything else right but are still not healing, you need to get serious about eating protein. For healing to begin and carry through to completion, you will need to eat 1 to 1.5 grams of protein per kilogram of body weight daily. Believe me, that’s hard to do, but absolutely essential. Besides protein-rich meals, handfuls of nuts and protein supplements may be needed to get there.

I’ll let you know how I do in my next column.