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Hi
I have just been referred a patient who has ulceration of both 1st mtpj/hallux amputation sites. The wounds are quite large and have been open for more than 2 years now, they are both quite clean and have good granulating bases, although the right wound leaks huge amounts of clear fluid, no one seems worried about this except me. The local GP also seems happy to allow this patient to walk around with 2 big holes in his feet for another 2 years!!

I am wanting to off load these areas, but work in a little pod clinic for public health, I don't have any facilities to cast and have little experience.

I was just wondering if anyone has used the Darco boots which off load the forefoot?? as I may be able to get some funding to buy some. Any info you have would be greatly appreciated.

Many thanks
The lonely one!!!

Hello lonely one

THis is what the internet is great for - helping out when you're in an isolated environment!

I would recommend, if you are not overly experienced, looking at getting the patient a removable cast walker with a rocker bottom (brands vary depending on what country you are in), from your local orthopaedic/podiatry supplier.

Dress the patient in the normal manner, continue and wound debridements, and get them to *live* in this boot until healed, then swap over and do the other foot (hopefully without the first side breaking down again). May take weeks to months.

Cheap and cost-effective, and no special skills required.

LL

LL do you also find that a pressure relieving EVA device is a necessary addition to the inside of the walking cast? Otherwise the shear forces on the wound are taken care of, but the pressure hasn't really been re-distributed..
Just a thought.. I know they do them quite a bit at one of the high risk foot clinics here.

regards,

Richard

A removable total contact cast(a boot wrapped with coban) will be helpful as it offloads and,as was said in a previous post,takes no special skills to apply.