WHAT IS A FOOT OR LEG ULCER?
An ulcer is an open lesion/wound that does not heal in less than two weeks. These now become chronic wounds that are prone to infection and form a layer of biofilm (bacteria that stick to each other and prevent healing) and bioburden (an excessive number of bacteria living on the surface of the wound). An excessive amount of bacteria prevents good tissue called granular tissue from developing and inhibits the healing of a wound.
WHY DO PEOPLE GET ULCERS?
Ulcers are caused by:
- Poor circulation (decrease in blood flow to the extremities)
- Venous insufficiency (the valves in the veins in the extremities fail to function and cause a pooling of blood and a slow down of flow)
- Peripheral neuropathy and nerve damage
- Lymphedema (fluid in the legs that remains stagnant and causes swelling)
- Smoking (whether past or present)
- Inflammatory diseases such as rheumatoid arthritis, lupus and gout
THE STEPS TAKEN AT CELLA FOOT & ANKLE SPECIALTY
An initial evaluation and medical history is performed in order to assess not only the wound but the patient as a whole. Each medical decision made is custom and tailored to a patient’s individual needs in order 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, noninvasive studies are prescribed and at times patients are referred to vascular specialists. If an infection is present, a bacterial swab is taken and sent out to help with decision making on antibiotic treatment.
Depending on the type of wound and severity of the wound, there are several treatments available after careful debridement of the wound (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 toes 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
- Patient’s home situation
- Smoking cessation
- Diabetic education
- Vascular tests & referrals as needed
- Nutrition assessment
FREQUENTLY ASKED QUESTIONS
Do podiatrists do wound care and treat ulcers?
Podiatrists are the key doctors to wound care. They are the ones to see first if you have a wound on your foot, ankle, or leg. They are the ones to manage the wound and build the team necessary for wound care.
Do wounds heal faster, covered or uncovered?
It is best to keep a wound covered and closed so it remains moist. The blood vessels and cells necessary to decrease inflammation and bring more blood flow to the wound increases when a wound is covered causing the wound to heal faster.
Can foot ulcers be cured?
When caught early, foot ulcers can be cured. It is pertinent that you see your podiatrist when you notice a sore. Healing an ulcer requires many steps.
- If the arterial circulation is compromised, decreased blood flow to the ulcer, then a vascular consultation is required to evaluate the patient and determine if any intervention is necessary.
- Keep blood sugar under control
- Debridement of the ulcer is necessary if the tissue overlying the wound is fibrotic (non healing tissue).
- Antibiotics are needed if there is an infection
- Compression garments/ lymphedema pumps are required when edema is out of control
- Collagen/ debridement/ antimicrobial dressings
- Skin substitute grafts
- Live tissue/ amniotic membrane grafts
- Total contact cast
- Unna boots
What are the 5 rules of wound care?
- Controlling the amount of blood in a wound. Known as hemostasis.
- Cleaning and debriding the wound.
- Preventing pain with analgesic medications and preventing infection with antibiotics.
- Skin Closure through suturing if the wound is small. Skin substitute grafts or autogenous graft ( skin taken from another part of the patient's body) if the ulcer is larger.
- Dressing the Wound and follow-up for evaluation.
What are the types of leg and foot ulcers?
Venous stasis ulcers - Are seen in patients who have leg swelling, varicose veins and a history of superficial or deep vein blood clots. These ulcers are usually found below the knee and on the inner aspect of the ankle.
Neurotrophic (diabetic) - These types of ulcers are mostly seen in patients with diabetes, although they can occur and affect anyone who has a decrease in sensation of the feet. They are usually seen on pressure points of the feet.
Arterial (ischemic ulcers) - These ulcers are seen in patients who have poor circulation and have other underlying conditions such as, diabetes, thin skin, renal issues or simply had trauma that initiated the process and poor blood flow did not allow healing of the wound. They can be located anywhere but mostly seen in areas where there is decreased blood flow such as the heels and the toes.
Is hydrogen peroxide good for diabetic wounds?
It is best to keep wounds moist and covered to prevent infections and allow faster healing. Hydrogen peroxide will only dry the wound and is not recommended as it could lead to further complications.
When is a diabetic patient at high risk for an ulcer?
A patient is at high risk for an ulcer if they have or do the following:
- Poor circulation
- A foot deformity (e.g., bunion, hammer toe, flat feet with a prominent medial column)
- Wear inappropriate shoes
- Poor and uncontrolled blood sugar
- History of foot ulcers
- Consuming large quantities of alcohol
- High cholesterol
Why don't diabetic wounds heal?
- Patients who have diabetes also have problems with their immune system. They do not have enough immune fighting cells to heal the wound and therefore the wound heals slower.
- If the diabetes is uncontrolled it will lead to poor circulation. With a slow down of blood flow, the body has a difficult time delivering nutrients to the wound. The wounds are again slow to heal.
- If a diabetic has a blood sugar that is higher than normal it will prevent oxygen from being delivered to the wound and it will not allow proper healing.
- High levels of blood sugar also increase the risk of infections to the wound. Bacteria loves sugar and thrives on it and with the immune system being down, infections grow causing a slowing down in healing and even possible complications such as amputations.
What are the 4 stages of wound healing?
- Hemostasis - This phase happens when the blood in the wound clots.
- Inflammatory phase – This phase begins at the time of injury and lasts up to four days.
- Proliferative phase – This phase begins about three days after injury and overlaps with the inflammatory phase.
- Remodeling phase – This phase can continue for six months to one year after injury.
What does a wound care specialist do?
Wound specialists are physicians who have been trained in the treatment of wounds. Podiatric doctors are trained to treat all types of wounds involving the lower extremity, acute and chronic.
Wound care specialists utilize wound care treatments that other doctors are not trained to perform. Seeing a wound care specialist gives you the best chance at healing. They use different forms of treatment to accomplish a successful healing. These include but are not limited to debridement, bioengineered skins, surgical incision and drainage, skin grafts, unna boots, total contact casts.
Wounds, if but treated properly can lead to amputations. It's is extremely important to find the best wound care specialist. Dr. Cella had been treating wounds for over 20 years. Your physical health and quality of life depend on the doctor you choose to treat your wounds.