By Bob Vogel - New Mobility - January 2017

Q.  I am 55 and in my 20th year as a T9 complete para. Over the past five years the skin on my feet has become quite fragile. I recently developed a pressure sore on my left heel from a minor bump on my foot rest during a transfer while I was barefoot. Although I managed to get in to see a wound care specialist within a week of the injury — when it was no bigger than the size of a pencil eraser — it took over a month of care and weekly visits to the specialist to heal it. It seems all of a sudden — through nightly mirror checks — both heels would be red from pressure. I’ve had to move to a full size larger shoe than usual to keep the pressure off my heels. Is this common in people with spinal cord injuries? Is there anything I can do about it? 
— Mark

A. Mark, the people I roll with have the same issues. At some point post-injury, the skin on our feet becomes more fragile, especially heels, around toes, and ankle bones.

To answer your questions I turned to Kathleen Dunn, clinical nurse specialist and rehab case manager. Dunn says that people with SCI have the same high risk for skin breakdown in their feet as people with diabetes — for similar reasons. Both groups have lack of sensation that can lead to scrapes and pressure sores. A slow healing wound on a foot or toe can quickly lead to infections such as cellulitis or osteomyelitis (infection of the bone). Edema (swelling) makes skin even more vulnerable. The good news is there are many steps that can and should be done to help keep feet healthy.

A good place to start is to avoid going barefoot, even around the house. Darryl Murphy, 58, in his 40th year as a T11 para, says, “In the first 20 years after my injury I lost toes from getting minor stubs and scrapes. I would go barefoot in my chair and stub a toe (or a few) and they would be very slow in healing. At the time I was a smoker, so it made healing even slower. Eventually an infection would set in, it would get into the bone, and then my only options were months of IV antibiotics to try and knock out the infection and hope it didn’t spread to the foot, or have the toe(s) amputated. I opted for amputation at an outpatient surgical center. I finally learned my lesson and now put on shoes before I get in my chair. And I quit smoking.”

Candace Cable, 62, in her 41st year as a T10 para, concurs. “I pay close attention to my feet because if I get any scrapes or wounds on them, it takes a long time to heal,” she says. “I always wear shoes. Even if I’m just getting up at night to use the bathroom, I’ll slip on a pair of shoes. Plus it prevents my feet from sliding when I’m doing transfers.”

Another area where it is all too easy to scrape a foot is during ... Read More