Unna boot is an old type of therapy which was once used widely to treat non infectious varicose veins venous ulcers. Today, this technique has fallen out of favor. It is a messy technique and the results are mediocre are at best. Most patients remain dissatisfied with the Unna boot.
Unna boot is a gauze bandage which is impregnated in zinc oxide, glycerin and calamine. It is believed that the zinc will act like an antibacterial and calamine lotion will stop the severe itch that occurs with the dressing. The Unna bandage is wet when it wrapped. The wrap starts at the ankle and moved up the mid leg. The Unna bandages are applied in a few layers of thickness.
After the wet bandage is applied, the Unna boot is molded into the shape of the leg and ankle. An elastic bandage is applied around it. In most cases, a new boot is applied every 1-3 weeks.
When the bandage dries, it produces a dry rigid but inelastic leg cast which prevents leg swelling and acts like a rigid stocking. Unlike compression stockings the Unna boot is rigid and does not squeeze the muscles.
The bandage offers compression to decrease the swelling of the leg. Once the dressing dries, it becomes hard and one can walk on the boot.
In most cases, the patients breaks the boot while walking on it (unlike a Plaster of Paris cast, Unna boots do not have that much durability). When the boot breaks it cuts and irritates the skin and does not function like it was intended. When the venous ulcer is open and draining, the boot may be required to be changed more frequently. In some cases, patients can't tolerate this bulky boot and want it removed, in some cases, proper foot hygiene can't be maintained and the boot has to be removed.
The Unna boot has to maintained dry; one can't shower in it, and one can't bath in it unless a plastic bag is worn over the Unna boot. After a few weeks, most people just want the boot out. In some cases, the leg swells and the pain is continuous and the boot has to be removed.
Which condition are not recommended for Unna boot therapy?
- Diabetics with foot ulcers
- Arterial ulcers
- Peripheral vascular disease
- Buerger's disease
- Radiation ulcers
Despite what is reported in the literature, Unna boot is an old fashioned therapy which has now been replaced by better, effective and more comfortable compression stockings.
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