Category: Medical Care

  • Beyond Redness: Identifying Pressure Injuries on All Skin Tones

    Beyond Redness: Identifying Pressure Injuries on All Skin Tones

    In the medical world, we are often taught that the first sign of a pressure injury is “non-blancable erythema”–a fancy way of saying a red spot that doesn’t turn white when you press on it.  But there is a significant flaw in that standard: it primarily describes how a wound looks on light skin.

    As an in-home Nurse Practitioner, I see patients of all backgrounds. If we only look for “redness,” we are going to miss early warning signs in patients with darker skin tones. When a wound is missed in its early stages, it has a much higher chance of progressing into a serious, deep seating injury.

    To provide the best care, we have to look beyond color.

    The Challenge of Pigmentation and Pressure Injuries

    In darker-pigmented skin, the “redness” phase may not appear at all. Instead, the skin may take on different hues, looking purple, bluish, or even slightly grayish. Because the changes can be subtle, the injury is often much more advanced by the time it is “visible” to the naked eye.

    This is why “skin of color” assessments require a more holistic approach. We aren’t just looking with our eyes; we are “looking” with our hands, and listening to the patient’s experience. 

    “Big Three” Signs to Indentify Pressure Injuries

    If you are caring for a loved one with a deeper skin tone, I recommend focusing on these three indicators rather than searching for a red spot:

    1. Temperature Changes: Before the skin breaks or changes color significantly, it will often feel different to the touch. Early on, an injured area might feel significantly warmer than the surrounding skin due to inflammation. As the injury progresses and blood flow is restricted, it might feel noticeably cooler. 
    2. Texture and Consistency: These are often the most reliable “early warning” signs. When you palpate (gently feel) the bony areas, like heels, sacrum, or hips, pay attention to the “give” of the tissue. 
      • Does it feel “boggy”  or mushy, like an overripe fruit?
      • Does it feel unusually firm or hard compacted to the surrounding skin?
      • Is there a “shiny” or taut appearance of the skin in that specific spot?
    3. The Patient’s Report of Pain: Never underestimate the patient’s “localized” pain. If a patient or loved one says a specific spot on their heel or tailbone feels “sore,” “burning,” or “throbbing,” treat it as a pressure injury until proven otherwise–even if the skin looks perfectly normal.

    Why Inclusive Assessment Matters

    Health disparities in wound care are a real concern. Statistics show that patients with darker skin tones are often diagnosed with pressure injuries at more advanced stages. This isn’t because their skin is “harder to care for,” but because the traditional tools for assessment weren’t designed with them in mind.

    By shifting our focus from color to consistency, temperature, and sensation, we can catch these injuries in Stage 1, where they are still reversible.

    Advice for Caregivers

    If you are monitoring a loved on at home:

    • Check in good lighting: Natural light or “cool” LED light is better than warm, yellow, indoor lighting for seeing subtle color shifts
    • Trust your touch: Your hands will often find a wound before your eyes will. 
    • Advocate: If a healthcare provider dismisses a spot because “it isn’t red,” don’t be afraid to point out changes in temperature, firmness, or the change from their normal skin tone! 
    • Color changes still happen! They just might look different than someone else’s. 

    Early detection is the best medicine. Whether skin is porcelain, olive, or deep ebony, the goal remains the same: keep the pressure off and the tissue healthy. 

    I’m currently accepting new patients in Marion and the surrounding donut counties. Contact Circle City Foot and Medical Care today at 317-269-7351 or visit circlecityfootandmedicalcare.com to schedule an appointment for your in-home foot care.

  • Why Your Back Pain Might Actually Be a Foot Problem

    Why Your Back Pain Might Actually Be a Foot Problem

    I often walk into a patient’s home and hear them describe a nagging ache in their lower back or a sharp pain in their hip. They are often surprised when the first thing I do is ask them to take off their shoes and socks. “It’s my back that hurts,” they tell me, “not my feet.” But what I see every day is that the body is a single, connected chain. When the bottom link–your feet–is out of alignment, every link about it has to compensate.

    The Kinetic Chain: From the Floor to Your Foot and Spine

    I like to explain the body using the concept of the “Kinetic Chain.” Your feet are the only part of your body that consistently touches the ground. They are designed to absorb the shock of every step and distribute your weight evenly. When I look at a patient’s feet, I am looking for the “foundation” of their movement.

    If you have a foot problem–wheter it is a painful bunion, a fallen arch, or even a thick, fungal toenail–you instinctively change the way you walk to avoid the pain. This is called antalgic gait. You might not even realize you are doing it. You may lean slightly to one side, shorten your stride, or stop rolling through your foot correctly. 

    The Ripple Effect of Gait Compensation

    When you change your gait to protect a sore foot, your muscles work in ways they weren’t designed for. If your arches collapse, your knees track inward, putting stress on the ligaments. This causes one hip to hike higher than the other, creating a tilt in your pelvis that pulls directly on the muscles of your lower back. I often find that a patient has spent months treating their back with heating pads, only to find the “root” of the issue is a corn or a callus that was forcing them to walk off-balance.

    My Role: Beyond the Trim

    One of the biggest advantages of seeing a Nurse Practitioner for your foot care is that I can look at the “big picture” of your musculoskeletal health. If I suspect that your foot alignment is causing significant issues, I have the authority to take the next clinical steps.

    • Diagnostic Imaging: If I am concerned about a structural deformity or a hidden fracture that is changing your gait, I can order X-rays or other imaging to get a clear look at what is happening under your skin.
    • Physical Therapy Referrals: Sometimes, the muscles in your legs and back have become so accustomed to “compensating” that they need professional retraining. I can write a referral for Physical therapy to help you regain your balance and strength.
    • Diabetic Shoes & Inserts: For my patients with diabetes, proper footwear is a medical necessity. I can perform the required exams and order specialized diabetic shoes and custom inserts that protect your feet while providing the support your back needs. 

    Finding the Right Foot Foundation

    When I am in your home, I also take a closer look at your closet. I look at the wear patterns on your soles to see if you are “over-pronating” (rolling in) or “supinating” (rolling out). If your shoes are worn out or unsupportive, your back will pay the price.

    I generally recommend looking for shoes with a firm heel counter (the back of the shoe shouldn’t collapse when you press on it) and a wide toe box to allow your foot to spread naturally. Brands like New Balance, Brooks, or Orthofeet often provide the structural integrity that aging feet require. 

    Finding Balance Again

    My goal is to get you moving smoothly again. When we take the pain out of your feet-whether through professional nail debridement or by ordering the right medical footwear–your gait returns to normal. Your pelvis levels out, and your back muscles can finally relax. If you are tired of chasing back pain, let’s start by looking at your foundation. 

    Your feet carry you through life—let’s make sure they’re up for the journey. I’m currently accepting new patients in Marion and the surrounding donut counties. Contact Circle City Foot and Medical Care today at 317-269-7351 or visit circlecityfootandmedicalcare.com to schedule an appointment for your in-home foot care.