Treatment of Pressure Sores on Lateral Foot
The optimal treatment approach for pressure sores on the lateral foot requires sharp debridement of necrotic tissue and surrounding callus, appropriate wound dressings selected based on exudate control, complete off-loading of pressure, and consideration of negative pressure wound therapy for post-surgical wounds. 1, 2
Initial Assessment and Management
Wound Debridement
- Remove slough, necrotic tissue, and surrounding callus using sharp debridement (scalpel, scissors) rather than hydrotherapy or topical debriding agents 1
- Sharp debridement is more definitive and controllable than other methods 1
- Take into account relative contraindications such as pain or severe ischemia 1
Wound Dressing Selection
- Select dressings primarily based on exudate control, comfort, and cost 1
- Ensure dressings maintain a moist wound-healing environment while allowing daily inspection 1
- Do not use dressings containing antimicrobial agents solely to accelerate healing 1
- Avoid footbaths as they induce skin maceration 1
Off-loading Strategies
Pressure Relief Methods
- Complete off-loading is crucial for healing 1, 2
- Options include:
- Total contact casting (TCC) or non-removable walker (preferred for plantar ulcers)
- Removable device when non-removable options are contraindicated
- Appropriate footwear that best offloads the ulcer
- For lateral foot ulcers specifically: consider shoe modifications, temporary footwear, toe-spacers, or orthoses 1
- Consider felted foam in combination with appropriate footwear when other forms of biomechanical relief are unavailable 1
- Instruct patient to limit standing and walking, and use crutches if necessary 1
Advanced Therapies
Negative Pressure Wound Therapy (NPWT)
- Consider NPWT to reduce wound size for post-operative (surgical) wounds on the foot 1, 2
- NPWT is not recommended over standard care for non-surgical diabetic foot ulcers 1
- NPWT can help manage complex wounds through improved granulation tissue formation 2, 3
Other Advanced Therapies
- Consider systemic hyperbaric oxygen therapy for non-healing ischemic wounds despite best standard care 1
- For difficult-to-heal wounds, consider:
Management of Infection
Assessment and Treatment
- Evaluate for signs of infection (erythema, warmth, tenderness, purulent drainage) 2
- For superficial infection:
- Cleanse and debride all necrotic tissue and surrounding callus
- Start empiric oral antibiotic therapy targeting Staphylococcus aureus and streptococci 1
- For deep infection:
Monitoring and Follow-up
Wound Inspection
- Inspect the ulcer frequently, initially daily for inpatients and every 2-5 days for outpatients 1, 2
- Monitor for:
- Decrease in exudate
- Reduction in erythema
- Development of healthy granulation tissue
- Resolution of systemic symptoms 2
Patient Education
- Instruct patients and caregivers on appropriate self-care 1
- Teach recognition of signs and symptoms of new or worsening infection 1
- During periods of enforced bed rest, provide instruction on preventing ulcers on the contralateral foot 1
Prevention of Recurrence
- Once healed, include patient in an integrated foot-care program with ongoing observation, professional foot treatment, adequate footwear, and education 1
- The foot should never return to the same shoe that caused the ulcer 1
Pitfalls and Caveats
- Pressure sores that appear uninfected may have associated infection of deeper tissues requiring specific diagnosis and treatment 4
- Avoid premature discontinuation of antibiotic therapy, which could lead to recurrent infection 2
- Do not rely on surface swabs for culture; obtain deep tissue cultures from the wound base after debridement 2
- Recognize that pressure sores in diabetic patients require special attention to glycemic control, with target blood glucose levels of 140-180 mg/dL during active infection 2