Experience with open-heeled Unna boot application technique.
One of the most common and effective treatments for venous stasis ulcers (VSUs) is the Unna boot dressing (UBD), first described by Unna in the 1890s. No one technique for UBD application has been documented by research to be the most effective for ulcer healing. This article discusses the open-heeled UBD application technique. Twelve patients with 17 VSUs that have been treated with the open-heeled UBD application technique are reviewed. The patients were primarily treated by the first author. Detailed patient education instructions are given. The open-heeled UBD is easier to apply patients are more comfortable and can fit into their normal shoewear condition of the heel can be monitored while the UBD is in place, and specially trained practitioners can apply UBDs with minimal to no compression on patients with concomitant venous arterial insufficiency. Ambulatory patients can also maintain greater ankle mobility during treatment. This may have important implications for activating the muscle pump under compression, which can facilitate blood return and reduce venous hypertension while the patient with venous stasis ulcer is ambulatory. The open-heel method may also allow greater mobility of the ankle that can help prevent "frozen" ankles associated with VSUs.