In order to heal a wound on the foot, three goals of proper wound care need to be accomplished. One, the right dressing needs to applied to the foot so that the skin can heal underneath. Two, the dressing needs to stay clean, dry, and secure so that bacteria has less of a likelihood of getting to the wound. Finally, pressure from the ground or the shoe covering the foot needs to be reduced so that the body can heal the skin without undue pressure being placed on the wound.
For the first goal, wounds need proper dressing in order for healing to accelerate. Based on modern research, the old adage that wounds need to dry in the air is incorrect. Follow these general instructions to ensure your wounds heal as quickly and safely as possible.
- Make sure your wound area is clean. Most of the time, the skin around the wound can be cleaned with a light amount of soapy water and a fresh, clean washcloth. Do not scrub the wound surface itself, unless your doctor lets you know its ok to do so. It is ok to pour sterile saline water over the wound if you want to flush the wound itself out. Once the surface around the wound is clean (and carefully dried), apply the first layer of the dressing as instructed by your doctor. This could be an antibiotic ointment, a healing cream or gel, or a specialized dressing material like collagen or silver impregnated material.
- Place gauze pads over the first layer. If the wound is on the bottom of the foot, several pads may be needed for pressure protection. Less is needed on the top of the foot and the toes. Your doctor will instruct you based on the needs of your specific wound.
- Apply roll gauze over the second layer to secure it on the foot. Your doctor will tell you if it needs to be wrapped further, such as to your ankle, for stability of the dressing.
- Use either Coban (self-sticking gauze) or tape to secure the end of the dressing together and keep it from unraveling.
For the second goal, it is very important that you keep dirt and water away from the dressing. Research has shown that bacteria can penetrate over a dozen layers of gauze. Dirt, standing water, and other liquids contain bacteria that can penetrate into the dressing through smearing of dirt/debris on the dressing or through soaking into the dressing. Bacteria not only causes infections, but it can also simply live around the wound, creating a layer of 'slime' that impedes healing. Your doctor will need to add additional treatment to your wound care if an infection or bacterial contamination develops. Therefore, you must never allow your dressing to get wet in the shower, or from spills, bathroom 'accidents', rain/snow, or other sources of liquid. You need to assume you should not expose your bare wound to shower, bath, natural, or pool water unless your doctor tells you otherwise. Likewise, do not walk across your house or elsewhere simply on your dressing. You need to protect the cleanliness of the dressing with a slipper, shoe, or walking boot (read below) to keep dirt and debris away from the gauze surface. Also, try to keep pet hair away from the dressing and out of your dressing changing area- those fibers get into everything.
Finally, reducing pressure to the skin around the wound is vitally important. A wound on the bottom of the foot that is not protected from the pressure of the ground, or a wound on top of the foot that is not padded from the top or sides of your shoe will not heal easily. For wounds on the bottom of the foot, your doctor may recommend the use of a walking boot or hard soled surgical shoe to offset pressure away from the wound, or may recommend your own shoes with a special pressure reducing insert. Sticking with their use at all times you are up and walking, whether it is away from home or simply going to the bathroom at night, is vitally important. Every unprotected step you take could prolong the healing of a wound on the bottom of the foot. Even stepping unprotected with only your dressing on across your carpet at home creates pressure on the wound. For deep or large wounds on top or the side of the foot, the bulkiness needed in a proper dressing may make the use of your regular shoes impractical. For this reason, a surgical shoe may be recommended. For smaller or more superficial wounds, a thin gauze or band aid may be sufficient to treat the wound, allowing for the use of your regular shoe. Your doctor will instruct you on what should be used to protect the wound site from pressure.