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Offload For Healing

Offload you wound, says Dr. Bruce Ruben of Encompass HealthCare & Wound Medicine, West Bloomfield, Michigan

Offload your wound: no pressure whatsoever
Is it important to offload your wound?

Do you follow your doctor’s orders to the T & offload your nonhealing wound? Or, are you like many of us who honestly follow the orders, but do slip up once in a while?

Well, in wound care, and particularly when we’re trying to heal a sore on the bottom of a foot, our “stay off it” and “no pressure whatsoever” really has to be followed completely. That’s called an offload. Consider the following vignette.

DOCTOR: “Stay off it. Don’t put any pressure on it. Certainly, don’t walk on it. No pressure whatsoever. See you in a week.”

A week goes by. The patient returns. The “unna boot” is scuffed on the bottom. The wound has been draining. No improvement in the wound despite last week’s stem cell application. Obviously no offload.

DOCTOR: “Hmmm…Did you walk on your foot?”


DOCTOR: “Did you put any pressure whatsoever on the bottom of your foot?”

PATIENT: “No, not really.”

DOCTOR: “How much is “not really?”‘

PATIENT: “Well, when I go up the stairs to bed, I guess I put a little pressure on it. But I do all the work with my other foot.”

DOCTOR: “Did I tell you not to put any pressure on it whatsoever? Remember we talked about the concept of offload?

PATIENT: “Well, yes. But how else was I going to get upstairs?”

At this point, the doctor must choose a response that helps the patient further understand how fragile and delicate these treatments are and how just the slightest disturbance can kill the stem cells and prolong the wound care healing process.

The great doctors are at peace with human frailty. They keep their egos in check so they don’t get angry when their work turns south. They forgive their patients because, after all, what is to be gained by chastising and making them wrong?

Plus, we know it’s not as easy as it sounds to put no pressure whatsoever on a wound — especially one on the bottom of a foot.

Still, your faithful wound medicine doctor would like you to know that it does hurt us when you suffer a healing setback. Our biggest joy is seeing you 100% completely healed and we want that joy sooner than later. Always.

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