Simple, creative devices in the management of plantar foot injury

Dear Editors,

Plantar foot injuries are quite common, whether acute or chronic, neuropathic or peripheral, vascular disease related, traumatic, or postoperative wounds. According to the physiology of the foot, it supports the weight of the entire body, and bears the friction and high pressure resulting from daily activities. Therefore, a wound located at the plantar foot is difficult to care for and also affects the quality of life of the patient. In plantar foot injuries, complicated wound dressing most often provided insufficient protection and resulted in poor hygiene due to gauzes easily falling off on contact with the patient's shoes or slippers.

Weight‐bearing pressure on the plantar is one of the most important factors that affect wound healing in the plantar foot. Deterioration of reduced blood flow, aggravation of the localized tissue ischemia injury and tissue destruction due to continued and repetitive synergistic effect of shear forces, friction and tension from daily ambulation worsen the wound healing process1. These wounds frequently become infected, cause great morbidity, engender considerable financial costs and may usually incite lower extremity amputation in worst circumstances 2. Thus, offloading the overly pressured forefoot can be considerably crucial in managing plantar wounds. A simple idea is to modify a slipper into a pressure‐diversion device. The base of a slipper was scooped out correspondingly to match the location and size of the plantar wound (Figure 1). The patient would therefore be able to walk with the modified slipper as less pressure was applied to the wound area (Figure 2).

Figure 1.

A chronic plantar pressure ulcer on a diabetic patient status post debridement for several times. A rhomboid local flap was used to approximate the wound.

Figure 2.

The base of a slipper was partially excavated according to the location and size of the plantar wound.

Adequate perfusion and pressure alleviation are the fundamental principles in the treatment of plantar foot injury. The base of the footwear must be excavated according to the size and location of the plantar wound, and must be able to accommodate the wound dressed with gauze, in order to reduce pressure caused by excessive mechanical loads and partially restore perfusion to the wound for a better healing environment. Using custom‐made slippers as above will lead to abatement of the pressure on the wound area of the plantar foot, facilitating recovery and early ambulation. This method might not have any apparent effect on patients living in big cities, but provides a cheap and easy‐to‐use equipment to those in impoverished remote areas.

Kian‐Yong Than, MD1,2, Ting‐Wei Chiang, RN1,2 & Tzong‐Shiun Li, MD, PhD1,2,3
1Department of Plastic Surgery
China Medical University Hospital
Taichung, Taiwan
2Department of Plastic Surgery
China Medical University Beigang Hospital
Beigang, Taiwan
3School of Medicine
China Medical University
Taichung, Taiwan.
li.tsa2@msa.hiet.net