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The European Pressure Ulcer Advisory Panel (EPUAP) describes pressure ulcers as localised injury to the skin, underlying tissue, or both, usually over a bony prominence, as a result of pressure or pressure in combination with shear.
In the case of foot pressure ulcerations, such as diabetic ulcers, the aetiology tends to be multifactorial involving risk factors as varied as peripheral sensory neuropathy, increased plantar pressures and micro-trauma.
The EPUAP classifies the different stages of pressure ulcers as – Stage 1: Non-blanchable Erythema, Stage 2: Partial Thickness, Stage 3: Full Thickness Skin Loss, Stage 4: Full Thickness Tissue Loss.
International pressure ulcer prevention guidelines recommend the use of a risk assessment tool to identify high-risk individuals and to implement early successful preventative strategies for pressure ulcers.
The National Pressure Ulcer Advisory Panel (NPUAP) divides these preventative measures into five key areas – risk assessment, skin assessment, nutrition, repositioning and use of support surfaces.
Various scales such as the Norton Scale, the Braden Scale and the Waterlow Scale have been developed as assessment tools to allow for the consistent mapping of the occurrence of risk factors or the indicators that support pressure ulcers.
The validity of these scales was measured in detail by Šáteková and Žiaková who conducted an extensive review to determine the predictive validity of selected pressure ulcer risk assessment scales.
By evaluating evidence levels from fifteen research-based studies, the authors established that the Braden Scale exhibited optimal validity in different clinical settings such as long-term care facilities, ICUs and hospitals and can be considered as a more reliable preventative measure.
A preventive podiatric care regimen should be adopted early to detect any impending foot problems especially in patients with diabetes. This should include a regular assessment of the lower limbs along with debridement of calluses and tissues.
Biomechanical imbalances, such as flatfeet, compound mechanical stresses by causing an uneven distribution of pressure across the feet which increases the risk of inflammation, particularly in high-stress regions.
Total contact foot orthotics such as MASS4D® aim to relieve pressure on the at-risk areas of the foot by distributing weight more evenly along the plantar surface of the foot. This creates a healing environment for the ulcer whilst permitting the patient to remain ambulatory during treatment.
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