Wound Care
An ulcer is an open lesion or wound that does not heal within two weeks. These chronic wounds are prone to infection and can form a layer of biofilm, bacteria that stick together and prevent healing, along with bioburden, an excessive number of bacteria living on the wound's surface. Too much bacteria prevents healthy granular tissue from developing and inhibits healing. At Cella Foot & Ankle Specialty, Dr. Cella brings more than 20 years of wound care experience to patients in Fair Lawn, NJ , treating the whole patient, not just the wound.
Why Do People Get Ulcers?
Ulcers are caused by:
- Poor circulation (a decrease in blood flow to the extremities)
- Venous insufficiency (when the valves in the veins fail to function, causing blood to pool and flow to slow)
- Diabetes
- Peripheral neuropathy and nerve damage
- Lymphedema (stagnant fluid in the legs that causes swelling)
- Smoking, whether past or present
- Inflammatory diseases such as rheumatoid arthritis, lupus, and gout
- Trauma
Because many ulcers are linked to diabetes and nerve damage, wound care works closely with our diabetic foot care and neuropathy services.
The Steps Taken at Cella Foot & Ankle Specialty
An initial evaluation and medical history is performed to assess not only the wound but the patient as a whole. Each medical decision is custom and tailored to the patient's individual needs to determine the best course of action. Tests may be performed, such as X-rays taken in the office, MRIs, or CT scans. If circulation is compromised, non-invasive studies are prescribed and patients are sometimes referred to vascular specialists. If an infection is present, a bacterial swab is taken and sent out to help guide antibiotic treatment. Depending on the type and severity of the wound, several treatments are available after careful debridement, the removal of all dead and infected material.
- Prescriptions for custom pressured compression stockings
- Multi-layered compression wraps
- Unna boots
- Lymphedema pumps
Dressings / Graft Application Treatments:
- Moist to moist dressings
- Alginate dressings
- Debriding agents
- Antimicrobial dressings
- Bioengineered grafts
- Amniotic membrane grafts
- Total contact casting and boots
- Pneumatic walkers
- Deep toe or special shoes
- Custom orthotics with offloading devices
Constant Patient Care including 30-Day Wound Evaluations:
- We treat the entire patient, not just the wound
- The patient's home situation
- Smoking cessation
- Diabetic education
- Vascular tests and referrals as needed
- Nutrition assessment
Frequently Asked Questions
Do podiatrists do wound care and treat ulcers?
Yes. Podiatrists are key doctors for wound care and are the ones to see first if you have a wound on your foot, ankle, or leg. They manage the wound and build the team necessary for successful treatment.
Do wounds heal faster covered or uncovered?
It is best to keep a wound covered and closed so it stays moist. Covering a wound increases the blood vessels and cells needed to decrease inflammation and bring more blood flow to the area, which helps the wound heal faster.
Can foot ulcers be cured?
When caught early, foot ulcers can be cured, which is why it is important to see your podiatrist as soon as you notice a sore. Healing an ulcer requires many steps, which may include a vascular consultation if circulation is compromised, keeping blood sugar under control, debridement of non-healing tissue, antibiotics for infection, compression for swelling, specialized dressings, skin substitute grafts, amniotic membrane grafts, total contact casts, and Unna boots.
What are the types of leg and foot ulcers?
Venous stasis ulcers are seen in patients with leg swelling, varicose veins, and a history of blood clots, usually found below the knee on the inner ankle. Neurotrophic (diabetic) ulcers occur mostly in patients with diabetes or decreased sensation and are typically found on pressure points of the feet. Arterial (ischemic) ulcers are seen in patients with poor circulation and are most common in areas of decreased blood flow such as the heels and toes.
Is hydrogen peroxide good for diabetic wounds?
No. It is best to keep wounds moist and covered to prevent infection and promote faster healing. Hydrogen peroxide only dries the wound and is not recommended, as it can lead to further complications.
When is a diabetic patient at high risk for an ulcer?
Risk is higher for patients with neuropathy, poor circulation, a foot deformity such as a bunion or hammertoe, inappropriate footwear, poorly controlled blood sugar, a history of foot ulcers, smoking, heavy alcohol use, or high cholesterol. Addressing these factors is an important part of prevention.
Why don't diabetic wounds heal?
Diabetes can weaken the immune system, leaving fewer cells available to heal a wound, and uncontrolled diabetes reduces circulation so nutrients and oxygen are delivered more slowly. High blood sugar also fuels bacteria, increasing the risk of infection. Together these factors slow healing and can lead to complications, which is why expert care is essential.