November 23, 2005
Other
Question from Trail, British Columbia, Canada:
Here at our geriatric center, we have an over 80 female resident with diabetes. She gets Humulin insulin twice a day and her sugars run from 5 to 13 mmol/L [90 to 243 mg/dl]. She has a black scab on her right heel that feels spongy underneath it. She is confused (dementia) and wheelchair bound. She is a DNR resident. We were given directions to treat her conservatively, per the doctor. We are presently wiping the scab with Betadine swabs twice a day. I am concerned about the treatment as Betadine kills tissue. I understand the theory behind the idea. Eventually, the scab will fall off and new tissue will present underneath. I have not experienced this before. I would like a second opinion as to what “conservative” treatment should be for this wound. It is approximately 3/4 cm wide and 1.5 cm long.
Answer:
I would recommend that someone familiar with foot wounds see the area on the foot from a medical perspective. It may be that there is necrotic material underneath the scab. In that case, the scab needs to be removed and the tissue debrided. This is a common issue with foot care. Not to debride the wound would be a potential reason for it never to heal.
JTL
