A guide for patients with wound or ulcer dressings

What is a dressing?

A dressing is a special kind of material that is applied to a wound.

What is a wound?

A wound is an injury where the skin is torn, cut, punctured or ulcerated (non-healing). Wounds vary in size and severity.

What is an ulcer?

An ulcer is a wound that does not heal quickly.

How do people get ulcers on their feet?

Injury

Any kind of injury to the skin can cause an ulcer. If the injury isn’t very serious and you are healthy, then the injury will heal normally. Otherwise it can lead to an ulcer. Poor fitting or unsuitable footwear commonly causes foot ulcers.

Poor circulation

Our skin needs good circulation to be healthy. If your skin quality is poor it is more likely to be damaged. You also need good circulation for your skin to heal normally and to fight infection.

Reduced sensation in the skin

If your foot is numb, then you won’t know if there is something causing you an injury. It also makes it harder for the ulcer to heal because you might keep damaging the same area without realising it.

Pressure and rubbing

If a toe sticks, up it is more likely that a shoe will press or rub on it. If the bottom of your foot isn’t smooth and straight then the prominent parts may get too much pressure from the ground. If the pressure or rubbing is severe, or goes on for a long time, the skin may get damaged and lead to an ulcer. It is normal to get hard skin on areas that receive pressure or are rubbed. If the hard skin is allowed to build up too much an ulcer may develop underneath it.

Health problems

Some health problems, such as diabetes, increase your chances of getting an ulcer on your foot. It may also mean the ulcer takes longer to heal and that you are more likely to get an infection.

How do you treat ulcers?

Prevent further damage

We may put some padding on your foot to help reduce pressure or friction on the ulcer, or to protect it from getting knocked. In some instances, you may need to wear a special insole or a cast, or even keep off your foot altogether until the ulcer has healed.

Remove hard skin

Some ulcers get a lot of hard skin around and even on top of them. This makes it more difficult for the ulcer to heal. We will remove the hard skin and any other matter such as dried blood or dead tissue that may cause infection or delay healing. Sometimes the ulcer bleeds when we do this. This is quite normal and nothing to worry about.

Signs of infection

It is normal for a healing wound to have some redness, a small amount of swelling and a light-yellow discharge. This does not always mean the wound is infected. Contact the Podiatry Service or your GP/111as soon as possible if you develop a significant increase in one or more of the following:

• Redness or a change in skin tone that is spreading
• Increased warmth around the wound
• Increased swelling
• Increasing pain or tenderness
• Thick yellow, green or cloudy discharge
• An unpleasant smell from the wound
• The wound is getting larger instead of healing
• You feel generally unwell or develop a fever.

The Podiatry Service is available during normal working hours, Monday to Friday. If you develop signs of infection outside these hours, at weekends or on bank holidays, contact NHS 111 for advice or seek urgent medical attention if your symptoms are worsening.

⚠ IMPORTANT INFORMATION FOR PEOPLE WITH DIABETES If you have diabetes, do not ignore the signs of a foot infection.Foot infections in people with diabetes can become serious very quickly and increase the risk of hospital admission, surgery or amputation if they are not treated promptly. • Contact the Podiatry Service or your GP as soon as possible if you think your foot is infected. • If the Podiatry Service is closed, contact NHS 111 for urgent advice. • Do not wait until the next working day if your symptoms are getting worse. • If you feel seriously unwell or think you have symptoms of sepsis, call 999 immediately.

⚠ SEEK EMERGENCY HELP IMMEDIATELY Could it be sepsis? Sepsis is a rare but life-threatening medical emergency. It happens when your body's response to an infection damages its own tissues and organs. Although uncommon, sepsis needs immediate treatment. Call 999 immediately if you have a foot wound or infection and develop any of the following: • Confusion or slurred speech. • Severe shivering, extreme muscle pain or feeling unusually cold. • Passing little or no urine. • Severe breathlessness. • Skin that becomes mottled, blue, grey, pale or discoloured. • Feeling that you might die. Do not wait for all of these symptoms to appear. If the Podiatry Service is closed, do not wait until it reopens. Call 999 immediately if you think you have sepsis. Tell the emergency call handler or healthcare professional that you have a foot wound or infection and are concerned about sepsis.

How often will I need to have treatment?

This will depend on the severity of the wound or ulcer and your general health. On average, it will be about once a week for an ulcer.

What do dressings do?

While the wound is healing a dressing may:

• help stop bleeding
• absorb any blood or other fluids
• ease pain
• protect it from further injury
• help prevent infection.

How long do I need to keep the dressing on?

This will depend on the type and severity of the wound or ulcer. Your podiatrist will advise you.

Does it matter if the dressing gets dirty?

To help prevent infection the dressing must be kept clean.

Can I have a bath or shower?

Dressings must be kept dry. If the dressing gets wet it may:

• increase the risk of infection
• change the way the dressing works so that it is no longer effective.

Your doctor may consider prescribing a protective cover so you can have a bath or shower.

Can I change the dressing myself?

We will usually advise you to leave the dressing in place until we see you again. In special circumstances we may ask you to change the dressing between appointments, particularly if blood or fluids are likely to come through the dressing.

Your podiatrist will advise you how to apply and secure the dressing.

To avoid infection it is important you follow a few simple rules:
• Always wash your hands thoroughly before changing the dressing
• Do not touch the wound
• Wipe the skin around the wound with a clean baby wipe or other skin cleaning cloth
• Dry the skin around the wound with a clean paper towel or let the air dry it
• Apply the dressing without touching the area that will be in contact with the wound
• Secure the dressing
• Wash your hands again.

Can the nurse change my dressings?

Sometimes, depending on the type of wound or ulcer you have and the sort of treatment it requires, we occasionally share the treatment of an ulcer with the nursing team.

How can I help myself?

Avoid further damage

It is important you take care not to damage the ulcer, as this will stop it healing. Make sure your shoe or slipper isn’t pressing or rubbing on the ulcer and try not to knock it.

Eat healthily

The food we eat provides the ingredients needed to keep us healthy and promote healing. Eat small regular meals and try to vary your diet to improve the chance of getting all the nutrients you need. We may recommend you see a dietician.

Keep warm

When we get cold the blood gets shunted away from our feet to keep our heart and other vital organs warm. So make sure you wrap up in cold weather. Never put your feet in front of a fire or radiator, or on a hot water bottle, though as this could make your ulcer worse or cause another one.

Improve your circulation

Gentle exercise will improve your circulation. Even if you are resting with your foot up, you should wiggle your foot from time-to-time to encourage the circulation.

Never wear tight footwear, or socks or stockings with a tight band around the top, as these will stop the blood getting to your feet.

Smoking has a harmful effect on the circulation and reduces the ability to heal.

Improve your health

If you have a medical condition make sure you follow your doctor’s advice. The healthier you are the
better your body is able to heal itself.

What if I have more questions?

Please ask your podiatrist if you have any further questions or there is anything you are not sure of.