Football Dressing for Neuropathic Forefoot Ulcerations
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Wounds were graded on initial presentation by the UTHSC wound classification system.33 There were 6 1A, 4 1B, 3 2A, and 2 2B wounds followed. Seven individuals required insulin and 8 did not. All wounds were plantar forefoot wounds of at least 6 weeks duration. The mean surface area of all wounds was 1.68 cm2 ± 2.81 cm2. Mean depth of the wounds was 0.16 cm ± 0.106 cm. Infected wounds had larger mean surface areas as compared to noninfected wounds, 2.71 cm2 and 0.984 cm2, respectively. A t test was applied to infected and noninfected wound healing rates. The single sided probability that the 2 variances are equal (F test) is 0.04798. Infection of the wound was not found to be a statistically significant factor in healing with the football dressing (P = 0.2). Total time to healing of the foot ulcers was 3.80 ± 2.60 weeks (range 1–10 weeks). No patients failed to heal the plantar foot wounds, and no secondary wounds were created with the use of this dressing.
The search for a repeatable, inexpensive, and efficacious dressing that addresses the need for nonremovable offloading of the neuropathic plantar forefoot ulcer is what led the authors to propose this model. Published studies evaluating the TCC consistently report mean healing times of 4 to 6 weeks.1–10 In this small study, the mean healing time was found to be about 4 weeks. Healing rate comparable with the gold standard of TCC coupled with low cost and ease of application has encouraged the authors to implement this technique into daily practice. Larger sample groups will be needed to determine any failure and complication rate associated with this technique.
Initially, variations on the dressing technique were attempted before settling on the method outlined. The authors encountered 1 patient who was a particularly aggressive ambulator and did not use his surgical shoe. He required a mid-week dressing change on 2 occasions. No infections developed during the football dressing therapy, and all dressings were changed at least weekly. All wounds were evaluated and sharp debridement was performed weekly. Moist wound healing was pursued as well as decreasing the bacterial load of the wound with use of a silver primary dressing.
The football dressing seems to limit 1 causal pathway in the formation of the neuropathic forefoot ulcer: trauma. In limiting this factor, wound healing can progress in an expedited fashion similar to that seen with TCC use. The dressing also meets the need for an affordable, readily available, and easily applied forefoot protector that is resistant to patient noncompliance due to its nonremovable nature. In this era of technologically advanced modalities for wound care, the football dressing would seem to be a worthy partner in the battle against the sequelae of neuropathic forefoot ulcerations.
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