By Tasneem Masqati and James McGuire DPM, PT, CPed, FAPWHc

The majority of the wounds of the lower extremity are of arterial, venous or neurotrophic (diabetic) origin.

Pressure ulcers are less common on the foot and ankle, however when present on the heel they are a particularly difficult wound to treat. Factors such as uncontrolled blood glucose levels, lack of mobility, increased age, impaired sensation, and unrelieved pressure or unlimited trauma all contribute to the development of these wounds.

Wound Dressing Design for Heel Pressure Ulcer Treatment

The Optifoam® Heel Wound Dressing by Medline Industries, Inc. was primarily designed to treat pressure ulcers of the heel. Heel ulcers are the result of unrelieved pressure, and repetitive friction or shear during movement or transfers. Heel ulcers may be considered to have the poorest prognosis among diabetic foot ulcers. Edmonds et al. reported that heel ulcers tend to be ischemic in nature, and that these ischemic heel ulcers heal less than 50 percent of the time. An important concept to understand in treating these patients is that the ulcer must be offloaded as well as provided with sufficient support. In addition, antibiotics, debridement, irrigation, and dressing changes all play a key role in the treatment of these ulcers.

The Optifoam Heel dressing is a highly effective option used by many physicians today. It consists of a highly absorbent film that creates an ideal healing environment. The outer layer is waterproof; thus, it prevents the entrance of microorganisms. Dr. Lesly Robinson, Assistant Professor and Chair of Temple University School of Podiatric Medicine, has been using the Optifoam Heel dressing since September of 2014. She states that her patients not only love how soft the product is but that they also praise how comfortable it feels. The cup is designed so that the heel falls perfectly in the center and that all portions of the ulcer are protected.

Indicated Uses for Optifoam Heel Foam Wound Dressing

Optifoam Heel dressing may also be an option for patients with skin grafts. Optifoam ensures that there is sufficient support and provides conditions for the graft to successfully incorporate into the patient. Patients who have diabetes and have peripheral vascular disease especially benefit. However, this product is contraindicated in patients with third-degree burns and lesions with active vasculitis.

It is strongly encouraged that when patients utilize the Optifoam Heel dressing, they remain non-weight bearing. The longer the patient is able to stay off of his or her foot, the more protection the Optifoam Heel dressing can offer. Unfortunately, some patients are unable to remain non-weight bearing as they are either overweight or are unable to use crutches. In such circumstances, patients are permitted to walk with the cup in place. For the majority of patients, including those with a skin graft, the Optifoam Heel dressing is utilized for seven days depending on the amount of drainage. For patients with highly draining wounds, they are told to change their Optifoam Heel dressing every 48 hours.

Upon speaking to a number of podiatrists, it has been noted that the Optifoam Heel dressing is comparable to the ALLEVYN* Heel dressing. Both products are similar in function, and one is not necessarily better than the other. It was also noted that although the Optifoam Heel cup dressing can be cut and modified, it still does not effectively conform well to every patient’s foot type. For example, patients who have Charcot foot often have an abnormal foot structure due to the degeneration of their joints; thus, these patients are unable to comfortably use this product. In such cases, additional dressing sizes may offer a solution to make heel cups dressings more adaptable to the patient’s foot.

Optifoam Heel dressing has proven to be an effective product that all physicians can appreciate. Its quality and design make this product one which is increasingly playing a role in the treatment of ulcers. Optifoam Heel has the potential to become one of the most widely used products for heel ulcers and gain success for many years to come.

Sources:
Edmonds ME, Blundell MP, Morris ME, et al. Improved survival of the diabetic foot: The role of a specialized foot clinic. Quart J Med. 1986;60:763-71.
Medline Industries. Optifoam Heel Wound Dressing. Medline. http://www.medline.com/product/Optifoam-Heel-Wound-Dressing/Z05-PF00167 Accessed February 10, 2015.

About the Authors:
Tasneem Masqati is a third year Podiatry student at the Temple University School of Podiatric Medicine. She graduated with a Bachelor’s degree from Rutgers University.

Dr. James McGuire is the director of the Leonard S. Abrams Center for Advanced Wound Healing and an associate professor of the Department of Podiatric Medicine and Orthopedics at the Temple University School of Podiatric Medicine in Philadelphia.