Foot degloving injury: From painful limited walking to 10,000 steps a day

Background

This patient sustained a degloving injury to her foot in a road traffic accident, resulting in extensive skin loss requiring skin grafting.

When I first met her, one year after the accident, she had received some physiotherapy but no specialist scar management.

Presenting problems

She continued to experience pain and swelling, which affected her ability to walk and limited her choice of footwear. She was also distressed by the appearance of her foot and felt self-conscious about wearing certain shoes.

She could walk for approximately 20 minutes using a stick before pain and discomfort became too much.

Clinical assessment and findings

The skin-grafted area was red, highly vascular and extremely adherent, meaning the scar was firmly attached to the underlying tissues rather than moving freely.

Some areas were concave (sunken below the surrounding skin), while the scar along the side of her toe was particularly raised and thickened.

Scar management

Treatment combined LPG, a mechanical method of tissue mobilisation, with manual scar mobilisation and an Otoform silicone mould to help soften and reshape the scar.

The aim was to improve scar mobility, pliability and contour while addressing the pain and functional difficulties affecting her everyday life.

Outcomes

Progress photographs showed improvements in the appearance and physical characteristics of the scar. It became less red and textured, more evenly contoured, and noticeably softer and more pliable.

The patient also reported a significant reduction in pain.

At her final appointment, she had recently returned from travelling, where she had been walking approximately 10,000 steps a day without needing a stick. This was a substantial improvement from the 20 minutes of walking she could manage when we first met.

What can we learn from this case?

Scar appearance and function are closely connected. Scarring can affect far more than appearance. Pain, swelling, tissue adherence and changes in contour can influence mobility, footwear choices and confidence.

Improvements may be possible after the initial healing period. Although this patient was already one year post-injury, improvements in scar characteristics, comfort and walking ability were observed during treatment.

A note about before-and-after photographs. The photographs in this case were taken during routine appointments rather than under standardised photographic conditions. As you can see, the lighting, positioning and angles are not entirely consistent. Although the improvements described were clearly evident on clinical examination and are reflected in the photographs, these differences are worth acknowledging.

When looking at before-and-after photographs, it's important to consider not only lighting, angles and positioning, but also how much time has passed between images, whether the scar may have changed through natural maturation, and whether any other treatments were provided during that period.

In this case, the injury was already over a year old, so the scar was beyond its most active stage of maturation, although further natural changes would still be expected. No other treatments were undertaken during the treatment period. The improvements observed over this relatively short time, particularly in scar pliability and contour, were greater than would be expected from natural maturation alone.