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
626-442-1223
www.elmontefootdoctor.com
Like our facebook fan page: http://www.facebook.com/drmichelesummerscolondpm
Please feel free to email me if you have any questions or if you would like to schedule an appointment, or you can visit our website or call our office.
dr.michele.colon@gmail.com
Showing posts with label foot ulcer. Show all posts
Showing posts with label foot ulcer. Show all posts
Friday, September 28, 2012
Saturday, July 18, 2009
How Should a Diabetic Foot Ulcer be Treated?
The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.
There are several key factors in the appropriate treatment of a diabetic foot ulcer:
•Prevention of infection.
•Taking the pressure off the area, called “off-loading.”
•Removing dead skin and tissue, called “debridement.”
•Applying medication or dressings to the ulcer.
•Managing blood glucose and other health problems.
Not all ulcers are infected; however if your podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.
There are several important factors to keep an ulcer from becoming infected:
•Keep blood glucose levels under tight control.
•Keep the ulcer clean and bandaged.
•Cleanse the wound daily, using a wound dressing or bandage.
•Do not walk barefoot.
For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.
The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.
Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.
For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.
There are several key factors in the appropriate treatment of a diabetic foot ulcer:
•Prevention of infection.
•Taking the pressure off the area, called “off-loading.”
•Removing dead skin and tissue, called “debridement.”
•Applying medication or dressings to the ulcer.
•Managing blood glucose and other health problems.
Not all ulcers are infected; however if your podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.
There are several important factors to keep an ulcer from becoming infected:
•Keep blood glucose levels under tight control.
•Keep the ulcer clean and bandaged.
•Cleanse the wound daily, using a wound dressing or bandage.
•Do not walk barefoot.
For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.
The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.
Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.
For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.
Thursday, May 28, 2009
Diabetes and Foot Surgery
One remark I hear frequently from my diabetic patients is that they have the belief that since they are diabetic, they cannot and should not have foot surgery. Is this true?
Let me answer this question by giving an example of a patient I saw in my office recently. She was referred by her primary care doctor for evaluation of sores on the ends of the third toes of both feet. When I first saw her, it was instantly evident that she had some serious problems. Not only were sores (ulcers) present on the ends of the third toes on both feet, but those same toes were red and swollen - classic signs of infection. I also noticed that she had severe contractures of the second, third and fourth toes of both feet. This caused her to put excessive pressure on the ends of the toes. It was this pressure that ultimately caused the ulcers to form, and became a hindrance in the healing of her ulcers. Further testing showed that not only did she have infected ulcers on both feet, but that the infection had progressed to the bone. After a lengthy discussion with her, we decided that it was best to remove the infected portions of the toes. For a podiatrist, this is not the kind of surgery that we want to perform, but sadly at times must be done.
Since her surgery, she has gone on to heal well, and what is left of the third toes on both feet is healthy and shows no signs of problems. However, she has since developed an ulcer on the fourth toe of the right foot. Again, because of the severe contracture of the toe (also known as a hammertoe), excessive pressure on the end of the toe has caused the skin to break down and ulcerate. So, we are back to fighting the battle to save her toe.
I gave this example to illustrate why surgery in diabetics is sometimes not only permissible, but can turn out to be a way to prevent more drastic complications at a later date. In the case of this patient, my plan now is to perform surgery on the remainder of her hammertoes in order to straighten them. This is not so that her feet will look better (although they undoubtedly will will better), but rather to remove deformities that are causing excessive pressure and make her prone to ulceration, infection, and potential amputation.
So, when can and should a patient with diabetes have surgery? In my mind, diabetes in and of itself does not mean that surgery is not possible. Rather, I look at the patient as a whole and determine if he/she is healthy enough to withstand the surgery, and heal properly afterwards. Things that your podiatrist will look for when contemplating foot surgery include the status of the circulation to your feet. This may involve not only an examination, but also non-invasive testing as discussed by Dr. Wishne in a prior post on this blog. In addition, your podiatrist will want to know how healthy you are in general. How is your heart functioning? How are your kidney's functioning? How well is your diabetes controlled? These and many other factors will be considered before surgery is contemplated.
Your podiatrist has had the advantage of seeing many patients who have developed diabetic foot ulcerations, and he knows the types of feet that are prone to develop such ulcerations. If your podiatrist feels that you are at an increased risk for developing a foot ulcer because of your foot deformity (including hammertoes, bunions, bone spurs, ingrown toenails, etc.), he will be doing you a big favor in recommending procedures that can prevent later complications. Every procedure in medicine has potential risks and benefits. The trick is to determine if the risk of surgery is less than the potential benefits that the surgery will offer. For most patients, pain is a major motivating factor to proceed with surgery. In a diabetic patient who may have neuropathy, prevention of future complications rather than the presence of pain is the main reason to proceed in many instances. This is a decision to be made jointly by you and your podiatrist.
Let me answer this question by giving an example of a patient I saw in my office recently. She was referred by her primary care doctor for evaluation of sores on the ends of the third toes of both feet. When I first saw her, it was instantly evident that she had some serious problems. Not only were sores (ulcers) present on the ends of the third toes on both feet, but those same toes were red and swollen - classic signs of infection. I also noticed that she had severe contractures of the second, third and fourth toes of both feet. This caused her to put excessive pressure on the ends of the toes. It was this pressure that ultimately caused the ulcers to form, and became a hindrance in the healing of her ulcers. Further testing showed that not only did she have infected ulcers on both feet, but that the infection had progressed to the bone. After a lengthy discussion with her, we decided that it was best to remove the infected portions of the toes. For a podiatrist, this is not the kind of surgery that we want to perform, but sadly at times must be done.
Since her surgery, she has gone on to heal well, and what is left of the third toes on both feet is healthy and shows no signs of problems. However, she has since developed an ulcer on the fourth toe of the right foot. Again, because of the severe contracture of the toe (also known as a hammertoe), excessive pressure on the end of the toe has caused the skin to break down and ulcerate. So, we are back to fighting the battle to save her toe.
I gave this example to illustrate why surgery in diabetics is sometimes not only permissible, but can turn out to be a way to prevent more drastic complications at a later date. In the case of this patient, my plan now is to perform surgery on the remainder of her hammertoes in order to straighten them. This is not so that her feet will look better (although they undoubtedly will will better), but rather to remove deformities that are causing excessive pressure and make her prone to ulceration, infection, and potential amputation.
So, when can and should a patient with diabetes have surgery? In my mind, diabetes in and of itself does not mean that surgery is not possible. Rather, I look at the patient as a whole and determine if he/she is healthy enough to withstand the surgery, and heal properly afterwards. Things that your podiatrist will look for when contemplating foot surgery include the status of the circulation to your feet. This may involve not only an examination, but also non-invasive testing as discussed by Dr. Wishne in a prior post on this blog. In addition, your podiatrist will want to know how healthy you are in general. How is your heart functioning? How are your kidney's functioning? How well is your diabetes controlled? These and many other factors will be considered before surgery is contemplated.
Your podiatrist has had the advantage of seeing many patients who have developed diabetic foot ulcerations, and he knows the types of feet that are prone to develop such ulcerations. If your podiatrist feels that you are at an increased risk for developing a foot ulcer because of your foot deformity (including hammertoes, bunions, bone spurs, ingrown toenails, etc.), he will be doing you a big favor in recommending procedures that can prevent later complications. Every procedure in medicine has potential risks and benefits. The trick is to determine if the risk of surgery is less than the potential benefits that the surgery will offer. For most patients, pain is a major motivating factor to proceed with surgery. In a diabetic patient who may have neuropathy, prevention of future complications rather than the presence of pain is the main reason to proceed in many instances. This is a decision to be made jointly by you and your podiatrist.
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