What is the diagnosis of a small, dime-sized sore on the lateral malleolus caused by a wheelchair in a patient with limited mobility?

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Terminology for Wheelchair-Related Lateral Malleolus Injury

This is a pressure ulcer (also called pressure injury or pressure sore), specifically a wheelchair-related pressure ulcer over the lateral malleolus. 1, 2

Precise Clinical Terminology

  • The correct medical term is "pressure ulcer" rather than "decubitus ulcer" or "bedsore," as these injuries result from unrelieved pressure over bony prominences, which the lateral malleolus represents 3

  • This would be classified as a device-related pressure ulcer since it results from wheelchair contact rather than bed surfaces 2

  • The lateral malleolus is a common site for wheelchair-related pressure injuries due to contact with wheelchair components during positioning and transfers 4

Staging and Documentation Requirements

  • A "dime-sized sore" requires formal staging (Stage I through IV) based on tissue depth involvement, which is essential for treatment planning 3

  • Stage I presents as non-blanchable erythema of intact skin, while Stage II involves partial-thickness skin loss with exposed dermis 1, 3

  • Documentation must include size, location, presence of eschar or granulation tissue, exudate characteristics, odor, and any signs of infection 3

Critical Clinical Context

  • Wheelchair users are highly susceptible to pressure injuries, particularly over bony prominences like the malleolus, due to sustained pressure and shear forces during sitting and transfers 5, 6

  • Even small Stage I pressure ulcers serve as important warning signs - while 50% may resolve quickly, 8.7-22.1% can deteriorate to higher stages without proper intervention 7

  • The lateral malleolus location suggests contact with wheelchair armrests, side guards, or improper positioning during transfers 4

Immediate Management Priorities

  • Pressure relief is paramount - the ulcer will not heal without eliminating the causative pressure source 2, 8

  • Visual and tactile skin checks must occur at least daily, with repositioning every 2-4 hours even with specialized cushions 2, 4

  • Specialized pressure-relieving cushions with gel inserts are indicated for wheelchair users with existing pressure injuries 4

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Pressure Ulcer Prevention and Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Research

Pressure ulcers: prevention, evaluation, and management.

American family physician, 2008

4
Guideline

Medical Necessity Determination for Lightweight Manual Wheelchairs

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

8
Guideline

Risk of Irreversible Tissue Damage in Pressure Sores

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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