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I believe that you're better off using vinegar soak for really sweaty feet and using Tinactin or Naftin instead of Neosporin. Also, try using Zeasorb AF in their socks on a regular basis to help with chronic athletes foot. If there is a bacterial infection then add Neosporin but place them on an antibiotic such as Cephalexin (Keflex). Also, regular use of anti-fungal creams will help prevents re-occurrence. Wet shoes must be eliminated and old shoes, i.e. 1 year replaced.

Dan K, DPM
 

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For athlete's foot, an antifungal cream would be much better than an
antibiotic. You're running the risk for resistant bacteria. MRSA is
already a huge problem in prisons as it is.
Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS
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Do these patients have any other risk factors? PVD?Diabetes? etc? You're sure they stem from an atheletes foot problem? Then why not use an antifungal ointment instead of bacitracin and skip the betadine.
Annie Bresnahan, R.N., A.D.O.N. twenty-six years long-term care experience/ wound nurse

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You need an antifungal to treat athlete’s foot. You can get it in many forms, cream, spray, powder. Micatin spray is an example. I usually use a spray on the actual athlete’s foot and then an antifungal powder, such as Remedy from Medline, in the shoes. Shoes may need to be replaced also. Just be sure to use the antifungal until the area is clear and then continue it for at least another 21 days or the infection could reoccur. Sue, CWS
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The treatments you are using will not help these wounds heal. The betadine solution is cytotoxic to new cells and the neosporin will not address the fungal infection. You should use only plain soap and water or normal saline to cleanse wounds. You need an antifungal appication to address the athlete's foot fungus and you need a cover dressing that wicks away moisture but does not dry out the wound bed. Try a foam dressing. You'll need a doctor's order for an appropriate antifungal agent that can be used on open areas.

Mary Ann Smeltzer, MS, RN, CWCN

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Hi, Rebekah

Do you treat the fungal infection that causes the athlete's foot? An antiseptic (Betadine) and antibiotic cream (Neosporin) would not kill the fungus.

Sara

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I THINK YOU SHOULD TRY AN ANTIFUNGAL CREAM OR OINTMENT AND LEAVE THE BETADINE SOLUTION ALONG. WASH THEIR FEET WITH ANTIBACTERIAL SOAP.

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They mean, usually in the case of a surgical incision, that the wound will dehisce. the edges will separate and it will open up instead of healing.

When used in reference to pressure areas, it means that the area is subject to damage from unrelieved pressure and will likely develop into an open wound.

Mary Ann Smeltzer, MS, RN, CWCN

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Hi,

Are you talking about a post surgical wound possibly dehiscing or breaking open?

A surgical wound should show signs of a healing ridge on either side of the sutures within a few days, a raised area that indicates that the healing is progressing. If it doesn't, or if the tissue on either side of the closed incision is soft and boggy instead, if the wound is weepy looking and open between the sutures or stitches, there is a good chance the wound will fully dehisce when the sutures or staples are removed.

Is this what you are referring to?

Sara, PT, WCC

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Has this patient had a surgical consult? Annie Bresnahan, R.N.

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I have used xeroform gauze covered by a 4 x 4 and wrapped with kerlix. change daily. this has worked very well in stasis ulcers in the past. use it up to when it is healed.  unsigned

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It may not be due to the compression. There may be other things causing healing delays, like having also not just a venous but arterial component
as well (and some depending on degree of arterial insufficiency will mean compression is contraindicated);
and a lot more other factors such as infection, medications, nutrition. Suggest to have a certified wound specialist
look at the wounds plus vascular studies.
Maria Carunungan, DPT, CWS

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Most patients with stasis ulcers have superficial venous problems, They can be treated with surgery,endovenous laser or radiofrequency and sclerotherapy one or some combination. A vascular
surgeon with interest in phlebology can help you KT
Kishan MD

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First, make sure they are venous ulcers. Many inflammatory ulcers such as those from rheumatoid arthritis, masquerade as venous ulcers. You need to look at the patient's history and medications and consider a biopsy. At least 20% of these non-healing wounds are malignant.

Next, do a culture and sensitivity of the wound bed. Not the slough, necrotic tissue, or surface. Often there is subclinical infection or severe colonization that prevents healing. If this is the case, you may need systemic antibiotics but you might try a silver dressing, iodosorb or Hydrofera Blue (least costly choice).

Third, what is the arterial circulation like? Were arterial studies done? If not, get some. At least 20% of venous ulcers have an arterial component that contraindicates many or all forms of compression therapy. then you have to use elevation instead.

Hope this helps.

Mary Ann Smeltzer, MS, RN, CWCN

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Hi,

Did you do an ABI to see if there was possibly concurrent arterial compromise? How necrotic is the wound? Is there an active cellultitis and if so, is the patient on antibiotics? Panafil is best for wounds that have at least some granulation and only partial necrosis, otherwise Accuzyme is better. What is the situation with drainage?

Sara, PT, WCC

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Are you sure you're dealing with a venous ulcer and not an arterial ulcer?
That could explain the worsening of the wound with compression.

I recently had wonderful results in healing a large arterial ulcer using
Panafil and dry dressing changed QD.

Good Luck!

Teddi, RN
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MAY NEED TO USE 25% DAKINS FOR 3 DAYS AND THEN USE HYDROGEL. KEEP LEGS ELEVATED AS MUCH AS POSSIBLE. GOOD LUCK. COATY,RN.CWS

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Try the Diapulse Wound Treatment System. Electromagnetic Therapy - HCPCS code is G0329. Covered by Medicare part B when treatment is applied in a hospital, nursing home or doctor's office. Get more info at www.diapulse.com We have had great success with venous stasis ulcers.

Thomas A. Sharon, R.N., M.P.H.