Monday, January 13, 2014

Preventative Surgery: Is There Such a Thing??

Is there such a thing as preventative surgery? We usually think of surgery as something that we need to fix a problem that is currently present. That makes perfect sense! Why would we ever need to have surgery when there is no current need for it? To the average healthy person, preventative surgery seems like too much of a risk. Why fix something that doesn't hurt? Every surgeon would agree that in most cases this is correct assumption. Lets think outside the box for a minute. I will give an example to make it easier: I have been seeing a diabetic patient for several months who has a callus on the tip of his toe. His toes bend and don't straighten well. They are stuck in that position (we call those hammertoes). This is why he gets the callus. No biggie right? Shave the callus and all is well right? Say this patient has very little feeling in their foot(they have diabetic neuropathy) and cannot tell if the callus is getting irritated and they do maybe a little more than usual that day. By days end, they may end up with swelling and redness to that toe! Now that is a problem! Shave the callus this time to find a wound under it! If all is working in the patient's favor, we treat the wound and, over time it gets better. Eventually though, a callus forms over the healed skin because nothing in the patient's lifestyle has changed. Over and over this is the cycle. Callus, wound, heals. Callus, wound, heals. That is the best it gets. It heals at least. Here is the sacrifice. Every time the wound heals, scar tissue is left. Scar tissue is not as flexible or forgiving as regular skin. It forms callus more quickly because it is less resistant to friction. Some times it doesn't matter that they are in the best shoes and inserts,(and seeing the best podiatrist here at FAANT!),the skin is just too vulnerable. The worst case is that eventually, and this happens more times than you can imagine, the wound gets infected and the infection gets into the bone! That could lead to an amputation!! Who wants to risk that? Surgery in this case is a feasible option! Even if there is no wound, surgery is a viable consideration. What if we could do a surgery to straighten the toe (while they have no active wound), so that there is less pressure at the tip? We may be able to halt that vicious cycle and make visits to our office much more pleasant! Much needs to be considered health wise to make the best choice for this patient as there are risks with any surgery, especially in a patient with health problems. Is there more risk having this surgery or to continue cycling with a wound that keeps popping up, increasing the risk of infection every time it does? Next time you visit, keep an open mind about this possibility. If preventative surgery is an option for you, we will do all we can to make sure it is done under the best of circumstances!

Tuesday, April 9, 2013

Grapevine Man Loses Leg from Diabetic Charcot

Are you diabetic with neuropathy?  If you are, then you know all about charcot.  Never heard of it?  Well, listen up.  This disorder is one of the leading causing of limb loss for a diabetic patient.  And it is the reason a patient of ours recently lost their leg.

Charcot (pronounced shark-o) is the break down of bones at the joint level causing deformity of the foot or ankle.  It occurs when the nerves around the joint are not longer functioning properly, thus preventing the feedback mechanism of pain.  Pain is what tells you that your shoes are too tight, you are walking too much, your shoes are uncomfortable, your arches are falling, etc.  Without this mechanism, you continue to walk and not know you are breaking down your joints.

This breakdown continues with each step eventually resulting in fractures or broken bones, dislocated joints and a deformed look to the foot.  The joints most affected are in the arch or center part of the foot.  This break down can cause severe dislocation that results in a large bump on the bottom of the foot that we refer to as "rocker bottom".  This prominence can then be a pressure point on the inside of the foot leading to ulcers that then lead to infection.  And if you've read previous posts, infection is the number one reason you will lose your leg as a diabetic.

How do know if you have Charcot?  Warning signs include:
- a very swollen foot and leg that started suddenly without an opening in the skin or any signs of infection
- the foot is starting to change shape, which occurs rather quickly
- a clicking sound when you walk barefoot (this is you walking on a dislocated joint)
- pain when you normally don't have much feeling in your feet

If you think you may have Charcot:
-  ice and elevate your foot
- don't walk barefoot
- apply an ace bandage or wear a compression sock to reduce swelling
-  call our office for immediate evaluation.  Charcot can often be confused with infection and vice versa.  A complete exam with xrays is necessary. Often you will be required to stay off the foot and wear a tall boot until the acute phase has passed.  After that, we will devise a plan to attempt further breakdown of the foot and possible amputation.

The best thing you can do to save your legs is see a podiatrist.  Call us today.

Monday, March 11, 2013

Stem Cell Therapy Improves Healing in Chronic Wounds

There is so much research right now using stem cells and we are finding so many wonderful applications where they can be beneficial in the foot and ankle.  But none better so far than in healing chronic wounds.

Now the stem cells I’m referring to are not used to grow an ear on a rat or clone a sheep.  These cells are obtained from human placenta immediately after child birth.  Learn more about that process here.  

How are they helping in wound care?  Healing a chronic wound can be challenging at best.  Make it a diabetic ulcer on the bottom of the foot and it can be almost impossible in a less than 6-8 months.  These ulcers are difficult to heal for several aspects.  Pressure from walking causes chronic trauma thus reducing the ability to heal.  The body’s own mechanism of filling a wound is often inefficient due to chronic disease.  Uncontrolled blood sugars add to this.  Bacteria can sit on the wound and may not be causing an infection but will prevent healing.  This list goes on and on.

And up until now we have tried numerous products to improve ulcer healing.  Some would be quickly beneficial.  But in the long term, it always took what seemed like an eternity to heal a diabetic ulcer.  Thanks to scientific research, I am now using live stem cells to close a diabetic ulcer often within 1-3 weeks.  

My approach to wound care is aggressive.  I know that if you have an open wound you are susceptible to infection.  This infection can be limb or life threatening.  So I want to close this ulcer as quickly as possible.  Here’s how I do it:
1st: culture the ulcer to see what bacteria is growing.  Antibiotics either pill form or topically may be started immediately to reduce this growth.
2nd: debride the ulcer.  This means remove all soft tissue that is no longer healthy from the ulcer and get a good bleeding base.  This brings the body’s own healing cells to kick start the process.  If your circulation is impaired, I may not be as aggressive with this step.  Alternatively, I may use a topical cream to slowly debride the ulcer for me.
3rd: offload the ulcer.  I want you in a special boot or shoe and possibly non-weight bearing so that I can take off as much pressure to the ulcer as possible.  
4th:  daily care.  You will be putting some kind of wound product on your ulcer daily followed by a dressing of gauze.  And keep your foot out of shower or bath water.  When you shower, there are several dirty areas between your scalp and your toes.  All of this dirt can end up in your ulcer!

I follow this regimen for 4-6 weeks.  If this does not work, the next step is stem cell therapy combined with a theraskin graft.

This is done in a surgery center setting so that deep debridement of your wound can be performed removing all nonviable tissue.  The stem cells are injected around the edges of the wound and throughout the ulcer base.  This does 2 things:
1.  stimulates growth of skin cells
2.  reduces the bacteria on the ulcer base
Next, I apply a theraskin graft.  This is cadaveric skin that has been donated just like a heart or liver for transplant patients.  But this graft has been treated to remove all living cells so there is no transfer of disease possibility.  This graft acts as an immediate skin covering.

Expect your ulcer to be significantly smaller if not healed within 1-3 weeks depending on size.  During this time, you will need to keep it wrapped with a gauze dressing and wear your boot or shoe at all times.  Minimal pressure to the foot is required otherwise you could injure the graft and stem cells, thus causing the entire thing to fail.

Sounds great, doesn’t it.  Well it is as long as these things are in check:
1.  You are keeping your blood sugar in control.  High sugar means failed graft.
2.  You are compliant with your post op regimen.  Non-compliance means failed graft.
3.  Take prescribed antibiotics as instructed until you are healed.  Too many bacteria means failed graft.
4.  Don’t get it wet.  A wet graft is a failed graft.

If you are dealing with a chronic wound that just won't heal and feel like you have tried everything, call us today.

Friday, September 28, 2012

Healing Diabetic Foot Ulcers

In my practice, I treat a lot of diabetic patients, and I see a lot of diabetic wounds. In this case, the wounds are called diabetic foot ulcers.

When evaluating diabetic foot ulcers, some of the things we look for as foot specialists are signs of infection, size of the wound, lab tests, blood sugar levels, shoes, and circulation of the feet and legs. All of these are important. Also, getting a good history from the patient is very important. We need to know how long the wound has been present, what medications have been given, and if any other treatments have been rendered yet.

As a podiatist, my main goal is to save my patients' feet. So this is a very important topic for me. We need the patient to help us do our job to heal the diabetic foot ulcer. Whether that means staying off of the foot or wearing a special boot, the doctor knows best when it comes to healing the foot ulcer. The longer the ulcer remains open, the higher incidence of infection (whether it be in the soft tissues or in the bone). And once it goes into the bone, that is when amputation occurs.

Dr. Michele Summers Colon, DPM, MS
3503 Lexington Ave.
El Monte, CA 91731

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Monday, April 9, 2012

Cuidado del Pie Diabetico

Una empleado de la officina Family Foot & Ankle Specialists explica los cuidado del pie diabeticos. Tenemos muchos tratamiento para pie diabetico.

Wednesday, March 7, 2012

Causes and Treatment for Diabetic Neuropathy

Dr. Peter Wishnie, owner of Family Foot & Ankle Specialists explains what the causes of diabetic neuropathy are and what treatment options are for the condition. Diabetic neuropathy can cause pain, burning, even amputations! You should regularly visit a podiatrist in order to prevent the complications associated with diabetic neuropathy.