Introduction
There are several special concerns that should be considered after a spinal cord injury. These concerns often relate to problems that could happen from absent or limited movement and feeling (sensation). This lesson will review issues related to wearing shoes, traveling, foot care, clothing and precautions for various heat sources.
Shoes
If unable to walk:
Shoes should be 1 -1.5 sizes bigger than usual. If you are wearing a brace inside your shoe, you may need to wear a shoe two sizes larger than usual. This is important because the feet may swell after the injury. If shoes are too tight, the skin on the feet can develop blisters or sores
Always check your feet carefully before you put on your shoes. If there is a sore, do not put on shoes.
If you have just bought new shoes or this is the first time wearing shoes since the injury, slowly increase the time you wear them as follows:
- Start with wearing them for 30 minutes.
- Take the shoes off and check the feet for redness or dark areas...pay special attention to areas over the heel, ankle and toes.
- If the skin is OK, wear shoes for an hour the next time.
- Check the skin again for redness or dark areas.
- If the skin is OK, add one hour each day until 10-12 hours are reached.
- If the skin remains OK, you can now wear your new shoes all day.
- Be sure to check the feet each time you take the shoes off.
- Avoid hard leather shoes. Softer leather is best because it tends to stretch more.
- If a red or dark spot is present when doing a skin check, a larger size shoe may be needed. Stop wearing the shoes until the red or dark spot goes away.
Traveling
Always do scheduled weight shifts when traveling in a car or other mode of transportation.
Always sit on your wheelchair cushion when in the car unless a different cushion has been prescribed for you.
Wear shoes when traveling so your feet will not get too hot touching the vehicle floorboards. If you have a sore on your feet, protect the feet by resting them on a pillow.
Always wear a seatbelt.
Foot Care
Inspect the feet, ankles, toes and toe nails everyday. Ingrown nails can cause infection.
Keep toenails clean and cut them straight across. Make sure to wash and completely dry the feet everyday (especially in between the toes).
Soak feet in vinegar to remove calluses
Use the following vinegar recipe:
- Apply a solution of one part warm water to one part white vinegar to a towel.
- Wrap the affected extremity (e.g., feet, hands) in the towel for 20-30 minutes.
- Scrub the affected extremity with the same towel.
- Do this once a day for three days.
- Do not do this if there are open sores on the skin in the affected extremity.
Heat Sources
Be careful of the following heat sources that can cause a burn to your skin:
Sun: In addition to the risk of sunburn, the sun can cause parts on your wheelchair to become hot and burn the skin. Wear sunscreen when out in the sun. Put it on all exposed areas, and especially over old scars.
Hot water: Burns from hot water can occur in the bath or shower, or as a result of coming in contact with exposed hot water pipes under the sink. Cover hot water pipes with insulating foam. Always test water first with a part of your body that has normal feeling/sensation. Set your water heater at 120 degrees Fahrenheit or less.
Space heaters: To avoid burns, do not get too close to a space heater.
Other equipment: Never leave Ankle Foot Orthosis (AFO) braces out in the sun. They will melt if they get too hot.
Clothes
- Be sure clothes are not too tight.
- Be careful of clothes with lots of stitching, pockets, zippers and snaps that might cause pressure marks on the skin.
- Always wash new jeans to soften them before wearing.
- Wear natural fiber clothing (cotton) because it breathes better.
- Dress for the outside temperature (if hot, wear cool clothes so you don't overheat; if cold, wear several layers to stay warm).
- Do not wear tight hose or socks unless they are support hose.
- Wear cotton underwear because it absorbs moisture and allows air to come in contact with your skin.
- You may prefer to not wear underwear if the elastic or seams bother your skin.
- It is always best to dress in layers so you can adjust to different temperatures easily.
