If you or a loved one experience difficulties due to wound management issues, the following information may be helpful to you:
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What is Off-Loading?
Off-loading means no weight-bearing on an extremity. If your doctor suggests that you should “off-load,” he or she means that you are not able to walk or bear weight on the extremity that has a wound, or the extremity where a wound appears likely to develop. This includes on your bottom or hips if you are bed or chair-bound.
Why do I Have to Off-Load?
When you have a non-healing wound, you must do everything possible to give your body a chance to heal the wound. The weight of your body when you walk puts a large amount of pressure on your feet and ankles. This pressure keeps the new tissue from growing and inhibits new blood vessels from forming. If you have a wound on your bottom or hips, to off-load this area requires that you do not sit or lie on the area where the wound is. If you continue to bear weight on a body part that has a wound, the time it takes to heal the wound increases, or, worse yet, the wound may not heal at all!
You may also be asked to off-load is you have problems with fluid retention that makes your feet and legs swell. People with chronic venous stasis have a higher risk of wounds developing on their legs when the fluids in their legs increase. If you have this condition, your doctor may suggest that you off-load as well.
How do I Off-Load?
There are a number of ways to off-load your legs and feet. The easiest way is to stay in bed, but of course that isn’t always possible. In some cases, however, bedrest is absolutely the best way to prevent further problems and your doctor may suggest this option for you.
You may also be prescribed a special shoe to allow you to be up on your feet periodically, but keep pressure off the wound when you are. The shoe is meant to be used for balance and stability but is not intended for walking. You may be prescribed crutches, a walker, or wheelchair to use with the shoe.
Once your wound is healed, you may need help to prevent new wounds from developing. Sometimes special shows fitted to your foot by an orthotist or other professional may be prescribed.
If you are chair or bed-bound, you may have a special seat cushion, mattress, or bed prescribed to off-load your bottom or hips. You may also need to be shown exercises that you can do in your chair to off-load for a few minutes at a time throughout the day. While in bed, you may need to turn from side to side, or back to prone, on a regular basis to off-load your bottom and hips. You may also have special splints or heel protectors to wear in bed to keep pressure off your feet and ankles.
In case of fluid retention, you’ll need to avoid standing and walking as much as possible. Your legs need to be elevated above the level of your heart to prevent fluid accumulation. (Propping your feet on a regular footstool won’t work!) Sometimes a recliner with pillows works when sitting. At night, you might elevate the foot of your bed in cinder blocks to get your feet up.
Off-loading is an important part of your wound treatment program. It is a part that only you can assure is accomplished. If you have any concerns about methods to off-load your wound, or feel that you might have trouble following the off-loading plan prescribed for you, talk to you doctor so that alternatives can be discussed that will work in your situation.