When compression goes awry…

We all have bad hair days. It’s a universal human experience. You usually just take it in stride and trust tomorrow your hair will look better. The same goes for compression wrapping! I have been compression wrapping for over 14 years and I’ll still do a bad wrap job on myself or a patient from time to time.

When I was a college student at Texas A&M, I woke up one morning a little later than usual and had to rush. I took a shower, lotioned up, fixed my hair, compression wrapped my leg, put my pants over my compression wrap, pushed my foot in my shoe, grabbed breakfast, and high tailed it to campus. Texas A&M is the best! It’s an engineering school and ironically the concrete jungle of campus is the just so poorly engineered for rainy days. It had been raining that morning and the majority of the campus was flooded. I accidentally stepped in a huge puddle of water and my compression bandages became soaked down the to stockinette. As I quickly walked across campus, I felt the bandages tightening up so much so that my foot began to cramp. I tried to continue walking as I developed a limp and had to stop. I was already late for class. My face started to feel hot; as my foot pain increased, so did my frustration. I made my way to a bathroom and took off my shoe, took off my pants, unwrapped my leg, re rolled the bandages, bandaged my leg in a bathroom stall, put on my pants, put on my shoe, wiped my tears, washed my hands and walked my butt to class. I will never know what I missed in first twenty minutes of ecology class. What I did learn was that you can expect bandaging and compression mishaps. They will happen. The real question is what will you do next?

Some common bandaging mishaps include:

A painful or numb foot. This can be caused by getting your compression bandage too tight around your foot . Or when you put your shoe on, the increased compression of the shoe is too much. When you sit too long and your butt falls asleep, lack of blood (or ischemia) occurs on your bottom. The nerves don’t like this and provide a numb or painful sensation to get you to move. This is also why people have low back pain who sit too long.

The solution: Movement! Therefore if your foot feels painful or numb, try moving a little to see if it subsides. Try loosening your laces on your shoes, especially above the mid foot. If these things don’t work and you’ve given it a few minutes, grieve the next twenty minuts of your day as repurposed for rebandaging.

Bandages that are coming unraveled. This happens if your tape that you are using is not strong enough or you didn’t overlap your bandages enough when starting a new bandage.

The solution: I recommend duck tape or gaffer’s tape for a good hold on bandages. The medical tape can do a good job; however in my opinion is not worth the extra money. When you finish with one bandage, I recommend overlapping the previous bandage at an angle where the starting bandage loose end can be covered. See self leg bandaging for an example of when this doesn’t occur. In this case, just use tape over the loose end to prevent it from coming unraveled.

Bandages that are slipping down. As you continue to move, you notice your bandage slipping down. If you are in a phase of reduction, this is normal because the starting volume of your leg dictated the tightness of the bandage. As your volume decreases, the tightness needs to be adjusted.

Solution: I recommend compression shorts if bandaging to the thigh. These can be pulled over the top of the bandage for increased staying capacity. Additionally, it is imperative that you have an optimal compression or tightness for the thigh as it tends to slip down. Make sure your stockinette and undercast padding/foam goes all the way to the gluteal fold.

Painful areas especially on the top of the foot, heel, or back of the knee. Remember that ischemia mentioned earlier? There are certain parts of the leg prone to increased pressure due to the irregular shapes that are common pressure points.

Solution: When bandaging the foot, make sure to keep your ankle flexed. When bandaging the knee, keep a small (20-30 degree) bend in your knee. If needed, add extra undercast padding around the ankle for more consistent compression. When in doubt, mention this to your lymphedema therapist to problem solve.

If you have any tips, feel free to make a comment below!

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