A client wearing a leg dressing faces a heightened risk of developing footdrop, a condition that compromises mobility and can prolong recovery. This complication arises primarily from the combination of immobility and potential pressure from the dressing or surrounding environment. The nurse’s goal is to implement a sequence of meticulous interventions to maintain the foot’s proper anatomical alignment and preserve nerve function.
Defining Footdrop and Associated Risks
Footdrop is characterized by the inability to dorsiflex the foot, meaning a person cannot lift the front part of the foot upward. This weakness or paralysis is typically a symptom of an underlying issue affecting the muscles that control this movement or the nerves that supply them. The most frequent cause is damage or compression to the common peroneal nerve, which wraps around the head of the fibula near the knee joint.
For a client with a leg dressing, several factors increase the risk of peroneal nerve damage and muscle weakness. Prolonged bed rest causes the foot to naturally hang in plantar flexion, where the toes point downward, due to gravity. This sustained position stretches the muscles and tendons on the top of the foot and shortens those in the calf, leading to contracture. Furthermore, the leg dressing itself, especially if tight near the knee, can directly compress the common peroneal nerve against the underlying bone. Heavy bed linens pressing down on the toes can also force the foot into plantar flexion, contributing to the problem.
Implementing Proper Positioning and Support Devices
The primary static intervention involves utilizing supportive devices to maintain the foot in a neutral position, specifically at a 90-degree angle to the leg. This neutral alignment counteracts gravity and prevents the Achilles tendon and calf muscles from shortening. A footboard or high-top orthopedic boot prevents the foot from dropping into plantar flexion while the client is in bed.
The nurse must ensure that any support device does not create pressure points, particularly around the sensitive area of the fibular head where the peroneal nerve is superficial. Proper application of a splint or boot should distribute pressure evenly across the foot and ankle, avoiding localized constriction. The use of a bed cradle is a simple mechanical solution. This frame is placed over the client’s lower extremities to lift the weight of blankets and sheets off the feet and toes, removing external pressure that forces plantar flexion.
To further protect the nerve, the limb must be prevented from rotating externally. External rotation of the leg can cause compression on the common peroneal nerve at the knee joint. Pillows or blanket rolls should be placed alongside the leg to maintain the hip and knee in a neutral, straight alignment. These static positioning measures protect both the nerve and the musculoskeletal structures while the client is immobile.
Active Nursing Assessment and Movement Strategies
Beyond static positioning, the nurse implements dynamic strategies focused on assessment and movement. Frequent neurovascular checks below the level of the dressing are necessary to detect early signs of nerve compromise. This assessment involves checking the toes for color, temperature, sensation, and movement, comparing the affected limb to the unaffected one. Any report of numbness, tingling, or inability to wiggle the toes should prompt an immediate inspection of the dressing for excessive tightness.
The client’s position should be adjusted on a set schedule, typically every two hours, to redistribute pressure and promote circulation. This repositioning helps relieve prolonged pressure that might build up under the leg or on the heel. The nurse must also incorporate range of motion exercises into the client’s daily care plan, provided the injury allows.
If permitted by the physician and the stability of the injury, the nurse should passively move the ankle through dorsiflexion and plantar flexion several times a day. These exercises maintain joint mobility and muscle elasticity, preventing contractures. Simple ankle pumps or active exercises, if the client is able, help to maintain muscle tone and stimulate nerve function in the lower leg.