Daily Inspection May Prevent Serious
Injury
by Angela Lindell
“When you can’t
feel your legs, you don’t ever really think about them,” says
Joe Mueller. “It’s like they’re not even there.”
Like many who have spina
bifida, Mueller finds that remembering to check his skin for injuries
each day is challenging. As a teen, Mueller even required surgery
for a wound that had gone unnoticed. But it was the experience
of another person that prompted Mueller to make some changes. “My foster sister lost a leg because
of a wound that became infected,” Mueller remembers. “That
was a big wake-up call for me.”
Today, with help from
his wife Barb, Mueller checks his skin daily for any sign of injury. “I haven’t had any issues so
far as an adult,” he says. “I’ve started taking
better care of myself.”
Low Sensation Equals High
Risks
For people who have spina
bifida, spinal-cord injuries, diabetes and other disabilities that
affect sensation, even minor injuries can be dangerous. That’s because the pain sensation—which
usually alerts the body to injuries immediately, before they become
more serious—is not always felt or recognized as an injury.
“Someone who can’t feel their feet might not detect
a wound until there’s infected drainage or odor,” says
Jill Gettings, M.D., a physical medicine and rehabilitation specialist
at New Brighton-based Gillette Lifetime Specialty Healthcare. “Some
wounds become so severe that they require surgery or amputation once
identified.”
Lack of protective sensation also places people at greater risk
of experiencing injuries in the first place. Anything from scalding
hot bath water to braces that have been outgrown might go unnoticed,
leading to burns, sores and infections. Edema (swelling) can also
cause pressure in an otherwise properly fitting brace or pair of
shoes.
Experience Leads to Change
After
witnessing such injuries first-hand, physical therapist Laura Pizer
Gueron says she thought health-care providers could do more to educate
and care for patients with sensation problems. “I
saw people in their 20s who needed amputations because of injuries
that they might have prevented or, at least, noticed sooner,” she
says.
After months of research, Gueron and a team of providers developed
new education practices aimed at preventing wounds in at-risk patients.
The strategies target patients from birth through adulthood.
For babies and children,
education involves parents and focuses on helping children develop
awareness of their lower limbs. “We
learned of research showing that when children with spina bifida
draw themselves, they often leave out their legs,” Gueron says. “We
realized that encouraging lower-body awareness was an important part
of encouraging self-care.”
Prevention Begins at Home
Because
providers only see patients periodically, diligent self-care by patients
of all ages and their caregivers is vital. “Daily
skin inspections and prompt medical attention could virtually eliminate
the more severe wounds and infections we see in patients with sensation
problems,” Dr. Gettings says.
That’s a message the
Muellers — who have three adopted
sons with special needs — take seriously. “Skin checks
happen every day at our house,” Joe says. “We’ve
also taught the boys different ways to prevent injuries. I’ve
seen how dangerous it can be if you don’t take good care of
yourself.” ![]()
Wound Prevention Tips
Serious
wounds and infections are preventable with careful hygiene and
daily skin inspections. Gillette staff offer the following prevention
tips.
Daily Skin Checks
Every day,
you should:
Inspect your thighs, buttocks, the tops and bottoms of your feet,
and the areas between your toes (use a mirror to look at the places
that you can’t see on your own)
Look for redness, blisters, sores, cracks, peeling and swelling
Feel your skin for hot areas
Report any problems to your doctor immediately
Careful Hygiene
Keep your feet clean and healthy by:
Washing daily using a mild soap and warm (not hot) water
Drying thoroughly with a soft towel
Trimming toenails straight across and smoothing them with an emery
board or file
Treating calluses, corns and other problems only after consulting
with a foot-care specialist
Good-Quality Shoes
When selecting shoes, consider the:
Fit: Shoes that fit properly offer cushioned support and never need “breaking
in”
Material: Leather shoes breathe better and offer more protection
than shoes made of vinyl or plastic, which don’t stretch and
can trap moisture and odor
Type and Shape: Shoes with high heels or pointed toes can cause skin
to break down. Open-toed shoes or sandals don’t offer protection
from injuries
Brand: Custom shoes with deep toe boxes help if you have such problems
as hammertoes or bunions
If you’re unable
to examine or care for your feet by yourself, ask someone else
to help you.
For more information about
lower-body skin care, or to make an appointment, contact Gillette
Lifetime Specialty Healthcare, 651-636-9443 or visit www.gillettechildrens.org.
