Introduction

Is there an irremovable offloading device suitable for lower extremity pressure injuries? “An irremovable heel offloading device encourages increased compliance,” says Dr. Lenz and Dr. Hussain within their poster presentation at SAWC, “Heel Offloading Posterior Splint for Treatments of Heel Ulcerations.”

However, most total contact casting (TCC) proves a greater risk of injury through iatrogenic complications and possible increases in pressure. Dr. Lenz and Dr. Hussain present the use of a particular posterior splint application method that may resolve possible complications traditional splints pose. With all the benefits of TCC, the heel offloading posterior splint (HOPS) is an irremovable offloading device that leaves room for the wound care professional to inspect the wound area or apply advanced therapies. In this interview, Dr. Lenz and Dr. Hussain share their experience and insights regarding this method.

What existing data led you and your co-investigator to conduct this research presented in your poster?

The authors of the poster acknowledge that most clinicians know that total contact casting is the gold standard for plantar foot ulcers. “Total contact casting (TCC) works because it is irremovable and offloads pressure from the ulcerated area,” they say. “Evaluating complications with the use of TCC, including increase in pressure at the heel as well as new ulcerations, macerations, and anterior leg abrasions is what led us to present this particular approach.”

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising?

The HOPS is a posterior splint applied in a normal fashion, but with offloading of the ulceration site, the authors explain. Rather than pressure being applied to a single area at the heel ulceration site, pressure is distributed throughout the foot and calf. “The HOPS has multiple benefits, including a custom fit to each patient,” they add. “This custom fit reduces issues with boot sizing. The HOPS can accommodate for patients with internal or external rotation. It can be easily removed by home nursing staff for dressing changes as well. Negative pressure wound therapy can be applied and changed easily as well.”

What are the possible real-world applications of these findings in clinical practice?

The HOPS can be a resource for patients who are non-weight bearing, say Dr. Lenz and Dr. Hussain. They find this method to be cost effective, accessible, time friendly, and easy to apply with minimal staff training. Ultimately, in their observation, it can also help heal non-weight bearing patients’ heel ulcerations, prevent infections, and preserve limbs.

Conclusion

For wound care professionals, the heel offloading posterior splint offers a unique path to healing patients. “We hope that this can assist health care providers in offloading heel wounds for non-weight bearing patients and lead to higher level of evidence studies to examine the HOPS as a viable offloading device for the appropriate patient.”

About the Presenters

Dr. Lenz is a Certified Wound Specialist Physician. He has a special interest in limb salvage and wound care including surgery to correct deformities causing lower extremity ulcerations. He uses the most technologically advanced wound healing treatments available. He has presented multiple research projects related to advanced wound care at national surgical conferences. He is a graduate of the New York College of Podiatric Medicine and completed a comprehensive medical and surgical residency at the Jesse Brown Veterans Affairs Medical Center in Chicago, Illinois, where he served as Chief Resident. Dr. Lenz completed advanced surgical training in Germany and England, where he worked with international experts in diabetic foot surgery. He is dual board certified by the American Board of Wound Management and the American Board of Podiatric Medicine. He is a member of the American Podiatric Medical Association (APMA).

Dr. Lenz is certified in hyperbaric medicine by the Undersea and Hyperbaric Medical Society. Dr. Lenz is certified in foot surgery by the American Board of Foot and Ankle Surgery.

Dr. Hussain is a foot and ankle surgery resident at RWJBH-Community Medical Center in Toms River, New Jersey. Fahad received his bachelor’s degree in biology from The University of Houston, and his medical degree from Temple University School of Podiatric Medicine. Dr. Hussain is surgically inclined and has a devoted interest in reconstructive surgery, limb salvage, cosmetic surgery, trauma, and minimally invasive surgery.