What is the plan of care for a patient with a partial thickness burn to the foot?

Plan of Care for Partial Thickness Burn to Foot

All partial-thickness burns to the foot require evaluation at a specialized burn center regardless of size, due to high risk of functional disability and permanent scarring. 1, 2

Immediate Initial Management

Cool the burn immediately with clean running water for 5-20 minutes to limit tissue damage and reduce pain. 1, 2 This cooling should only be performed if the total burned body surface area is less than 10% in children or less than 20% in adults, and the patient is not in shock. 3

• Remove all jewelry from the foot before swelling occurs to prevent vascular compromise. 1, 2
• Clean the wound with tap water, isotonic saline, or antiseptic solution. 1
• Do not apply ice directly to the burn as this causes additional tissue damage. 1, 2
• Do not break intact blisters as this significantly increases infection risk and delays healing. 1, 2, 4

Pain Management

Administer over-the-counter analgesics such as acetaminophen or NSAIDs for pain control. 1, 2 For severe pain, multimodal analgesia with titrated medications based on validated pain assessment scales should be used. 3

Topical Treatment Protocol

Apply a thin layer of petrolatum-based antibiotic ointment (such as triple antibiotic ointment containing bacitracin, neomycin sulfate, and polymyxin B) as first-line treatment. 1, 2 This promotes faster reepithelialization and reduces scar formation compared to other agents. 1

• Cover with a clean, non-adherent dressing after application. 1, 2
• Change dressing daily or as needed. 1
• Avoid silver sulfadiazine as first-line therapy as it delays healing and worsens scarring. 1, 2, 4

Alternative agents if petrolatum-based ointment is unavailable:

• Honey shows benefit with decreased mean healing time of 7.8 days compared to silver sulfadiazine and reduced hypertrophic scarring. 1
• Nanosilver foam dressings demonstrate faster re-epithelialization and healing in partial-thickness burns. 5

Critical Referral Criteria

Immediate specialized burn center evaluation is mandatory for all foot burns because:

• The foot is a high-risk location for functional disability and cosmetic deformity regardless of burn size. 1, 2, 4
• Inadequate management leads to hypertrophic scarring, contractures, and permanent hyperpigmentation. 4

Additional indications for immediate specialized care include:

• Burns greater than 10% total body surface area in adults (>5% in children). 1, 2
• Circumferential burns. 1
• Blue, purple, or pale extremities indicating vascular compromise. 1
• Signs of inhalation injury. 1, 2

Common Pitfalls to Avoid

• Never use butter, oil, or home remedies as these exacerbate the injury. 1, 2
• Do not use silver sulfadiazine for prolonged periods on superficial burns as it delays healing. 2, 4
• Do not delay seeking specialized care for foot burns, as location alone mandates burn center evaluation. 1, 2
• Inadequate pain control and failure to use appropriate moisture-retentive dressings compromise healing and increase scarring risk. 4