The Use of Felt Foam to Offload and Heal Malleolar Pressure Injuries

Introduction: In the outpatient, wound care center setting, it is not uncommon for patients to present with malleolar pressure injuries. While there are many devices to assist in offloading these areas, the availability to acquire them, the ability to utilize them appropriately, and their cost often limit their use. We describe the use of felt foam to treat malleolar pressure injuries.

Summary: Case 1: A 74-year-old male who became paraplegic due to an accident at age 63. He lives alone independently with limited resources. He presents to the wound center with a coccyx and a stage 3 left lateral malleolar pressure injury. The wound resolves with the use of felt foam over the next 15 weeks.

Case 2: A 71-year-old female paraplegic with a stage 3 left lateral malleolar pressure injury, which developed during a period of lower extremity edema a month before. Over seven weeks, we utilize felt foam in a U-shape around the malleolus for cure.

Case 3: An 84-year-old male paraplegic patient presents with edema and a stage 3 right lateral malleolar pressure injury for the past eight months. We used felt foam to offload the area along with a compression to heal the patient in three weeks.

Method: To offload an area of pressure, we utilize ¼-inch felt foam, which is available through any hospital supply department or online. The felt foam remains in place for up to one week. These patients were all paraplegics who spend most of the day in wheelchairs, where the risk for lateral malleolus pressure injuries is high due to the increased edema, lack of sensation, and the activity of the leg against the leg rest.

Conclusion: We continue to follow the patient weekly for any adverse effects of the dressing (slippage, congestion, moisture, etc.).