Okay, the C.R.O.W. is relieving all the pressure on Alan's ulcer. So far so good. We had to jerry-rig the front of the boot because it was rubbing on Alan's psoriasis. When we left the Foot guy (the day we got the boot), Alan immediately felt the rubbing on the psoriasis lesion (a bit below his knee). he said "uh oh, I feel this on my psoriasis"

The foot guy was with us when this happened and he said "Alan needs a long sock up to the knee. I then said "well, with the other boot, we used to use padding, moleskin, lambswool, can't we just put this right over the sock?" and the guy said: 'No, it has to breathe". Then he told us "if you see any marks on the leg, don't wear the boot, call us and we'll adjust the boot.

So we went home, I made him a diabetic sock by sewing two socks together. THIS DID NOT DO THE TRICK. There were no marks on the rest of the leg (but it was rubbing on the psoriasis lesion).

So Alan got disgusted and said: "listen, I'm going there on June 11th. This boot is GREAT for my foot ulcer, I don't even feel it, but I need something to pad the front.

So I bought some lambswool (It says FULLY BREATHEABLE) on the front of the package.

I cut two pieces of some old thermal underwear, (from the sleeves).

I put Alan's regular diabetic sock on. I then put the thermal underwear sleeve piece over he top portion of his leg (over the psoriasis), I then put the piece of lambswool over that. Then I went over to the other boot and took out a piece of the padding, and inserted that over the whole thing. (now it's fully cushioned, and NOTHING IS RUBBING ANYTHING).

Alan has been walking around like this and he feels NO RUBBING. I know the guy said not to do this, but it's the only way for Alan to function unti he gets back there on June 11th.

We check for marks every day. There are no marks anywhere. The only thing is we had to do the padding, or his psoriasis would have been irritated. There is no irritation any more.

The foot ulcer (now here's where my question comes in).

The foot ulcer is fine. No pressure (it's obviously being oft-loaded by the C.R.O.W. boot.

I looked at the foot ulcer this morning. (I'm the one who puts the whole thing on his leg after cleaning his foot, because he can't shower yet).

So I looked at the ulcer and it's not bleeding, (I have no idea how to tell if something is in the healing process because there is callous around the ulcer).

His ulcer has not formed any NEW callous because he never puts the foot down on the ground. He goes from the C.R.O.W. boot to the bed, and vice versa.

I said to him this morning. "I wonder if the ortho guy will debride this when you go back on June 11th." I said this because of the callous around the ulcer.

I have no idea what will happen when we go back. We will tell the shoe guy what we had to do with the front of the boot, and maybe he can adjust the pressure by re-padding it (I have no idea).

But do they debride an ulcer (as it is healing)? I know that when they debride they made a new hole, and it bleeds, and then it heals. But this is the first time that Alan has had the thing completely oft-loaded.

So (and this is for anyone who has been through this), do they just leave the ulcer alone, and the callous goes away in time, as he wears the boot for a few months, or however long it takes??

Or will the doctor debride it, wrap it up, and say "come back in two weeks".

One will think that he would debride it, and because Alan never puts any weight on it, THEN THIS MIGHT BE THE WAY IT WILL HEAL FOR GOOD!!!

I'm just curious. Will they cut away the remaining callous, or leave it?

Do callouses eventually come off or dissolve without being debrided??

Thanks to anyone who knows.

Melody

I have no idea about Alan's boot.

But calluses form where there is stress. They don't as a rule grow where there
is no pressure.

However, with a person with psoriasis, the psoriasis may activate from any
stressor. I wonder if Alan's healing problem is connected to psoriasis too?

One thing you can consider... poor omega-3 status increases callus and dry skin.
When we started them over 10 yrs ago, I lost all the calluses on my feet (and that was with standing at work 8-14hr days).
You say that Alan doesn't eat fish? Where does he get the essential omega-3's in his diet? We must have them you know from food or supplements if the food is not eaten. Omega-3's are used by the body to form skin, mucus membranes etc. Of the omega-3 family the flax oil it the most useful for the skin. Think about that. I have a thread on vitamin forum all about it.
My husband has psoriasis and he uses both flax oil and fish caps. I also buy foods with them in it. (some eggs now come with Omega-3, and Olivio spread or Smart Balance have them.) His psoriasis is more or less under control with no ointments.

I don't understand how there can be callus when he was not walking on the foot? You need to ask the doctor. I don't think an ortho MD would be working on callus however. Psoriasis patients can turn over skin up to 10 times faster than people without it. So it might be a factor.

It sounds like you came up with solution for padding the boot. . . as I was about to suggest Thorlo stockings make a variety of well-padded socks. I wear the "uniform" over-the-calf sock, as it is not so tight that my leg swells above it, and it is a light support stocking. (Crew length socks make my legs swell just above the top of the sock . . . ugh! ) Back in my mountaineering days I wore Thorlo's that had padding up the shin to protect against rubbing by boots, and they were great! But they might be a little too snug for your use.

You can check them out here: http://www.thorlo.com/

Thanks about the info on the Thorlo. I'll go and check right now.

Mrs. D.

Alan has had psoriasis for over 20 years. The lesions come and go. We've tried everything. Alan's ulcer has nothing to do with his psoriasis. He has somekind of bone impinging thing near the ulcer. That's why they did the C.R.O.W. boot.

He heals just fine. Always has. If he didn't have this bone impinging thing, he would have no problem with the ulcer healing. But he never let it heal all the way through before he walked on it. That's why this C.R.O.W. should let this heal completely. It oft loads the ulcer completely.

This callus is left over from before he had the operation. Alan has had it debrided only two times since the operation. And he has walked on it (BEFORE THE C.R.O.W.).

My question is this. Now that he IS NOT PUTTING ANY PRESSURE on the foot ulcer area, will the callous around it melt away?? Or do you think the doctor will debride it on the 11th? I think he'll say "oh, it's healing nicely, let me debride it". Or he'll say "you should go to your podiatrist and let HIM debride it' Now why would he say this, if he's the one who debrided it the last two times. Alan has seen so many doctor's I'm getting all flubustered over these visits.

And Alan eats plenty of fish now, and takes Flax seed every day. So he gets plenty of Omega 3.

His psoriasis is everyplace but his feet. On his elbows, on the shin of one leg (not the other. We got rid of the ones behind the ears. I use Vitamin E Oil and A D and E ointment. It helps a great deal.

This is all auto immune. At least this is what his doctor has told us.

There are more expensive psoriasis treatments out there, but honestly, when we use the Vitamin E oil and then slather on the A D and E ointment, well it gets much better.

BUT.... the boot goes to the knee, which prevents any air from getting to his foot. Thats the down side of wearing a boot. No air goes to the lesions.


P.S. We use Olivio every day. I love it!!

out, these things take a VERY long time. Often years! It is not unusual.
You have been doing all you can and simply put...if ALAN doesn't fully understand HIS own limits, you will have to be the 'patcher'.
Web up 'diabetic foot infections'...and you will find a lot of research about such issues and treatments. YES I KNOW! Alan does not have a diabetic issue, but nearly all research and therapy comes from that pool of experiences. Treatment is the same for pn'ers - diabetic or not. Read it and heed it! Here is one example: http://www.emedicine.com/med/topic3547.htm
The potentials for some sort of 'infection' to the bone is THERE and one has to be beyond super cautious! It is a scary proposition.
I have known of diabetics w/PN who have been hospitalized for 5 and 9 weeks respectively due to foot infections that they did not feel -in intensive care. It is all a nasty and really debilitating circumstance and I admire you for your persistence. I do worry tho at times...why isn't Alan taking a more part in any of his own care? I know you two are devoted to each other, but, as a guy, a GUY would want to 'do it himself'! for the most part.
One other option for foot-wrapping between skin, socks or whatever? Is what my podiatrist calls a 'pre-wrap'. It is a soft, breatheable flexible felt-like wrap that doesn't abrade between the foot and anything on top of the wrap. It's NOT cheap stuff! But, it does work.
Callouses do not dissolve or anything w/o debridement. This is always an/some abnormal formation of skin to 'protect' itself, rightly or wrongly.
The excess skin growth around the 'site' must be cut away. There are times when this growth can be good in healing, but in FEET it is NOT! Sometimes callouses growing on feet can be dangerous. I know from long prior experiences.
I suspect that all this will be discounted as it is from me. I am disappointed because I only am wishing Alan the best in the long run. 's -j

I'm not discounting anything at all. I agree 100% with everything you said. What is the name of this pre-wrap stuff? If I can afford it, I'll get it.

Alan takes as best care of himself as possible. I believe he has Aspergers and that our son inherited it from his father. Alan was never social, but being married to me, after 28 years, well, he's the social butterfly of our neighorhood now.

It's just that I know more medical stuff than he does. I only do the boot thing in the morning. After that, he's on his own. He takes it off when he's on the couch, and puts it on if he wants to walk to the computer room.

I think he's learned his lesson as far as going to the gym, going on treadmills. This will not happen again.

He paces himself now. He's had neuropathy for 18 years. I cut him a lot of slack because of this.

Melody

Bob started wearing a boot for 15 yrs. do to our head on collison and the brace up to his knee,You did a crative job on the soak.The socks
L.h. reccomended are very good I think she gave you a web site,or sporting good stores...Where his brace was made up have written up paper work
insurace pays for it.the raps.

Bob's is not only his foot but up his knee to get him out the car took hrs.,
He;s been through a lot,but he's 78 and does a great job of taking care of it his rehab insisted he learn,he's glad now he did it was tiresome at first.
Good luck. Bob siad for him to try and leave the hands off the psoriasis along in the part,a rehad nurse yell so loud nobody scratched for a week.lol Just be glad there not Diabetic.With my cancer I'm also glad he learned, Sue

I read an article that said that most mouth ulcers are caused by gluten intolerance. I wonder if that relates to all ulcers? I'm battling a mouth ulcer and so is my husband (strange thing). But we've both been under a lot of stress lately. Melody, I hope Alan's foot continues to improve.

Billye

Thanks Billye:

Since we know for a fact why Alan has the ulcer, the only goal we have now is that as he continues to wear the boot, over time, the ulcer will heal.

If it does not (and the only way we'll know this, is when the time comes and he goes from the C.R.O.W. boot to the custom molded shoes. and if THE ULCER COMES BACK (and this WAY down the road for him), then the only alternative is the osteotomy that the Orthy guy will perform. He explained the whole thing to us. Shaving down the bone alone WON'T ACCOMPLISH ANYTHING. He explained this to us also.

So this is a wait and see thing for us.

I hope you get rid of that mouth ulcer. Never had one. Doesn't sound comfortable?? Is it painful? What do you do, Rinse with something, some antiseptic stuff, or maybe apply vitamin E to it??

I put E on everything. Sometimes it works, sometimes not. But if the body is under stress, the first thing is to take the stress away.

NOT AN EASY THING TO DO, this I know!!!

Take care,

Melody