Diabetic foot ulcers are serious! Foot wounds account for the most days missed from work, more hospital days, and the most amputations of any other disease in the world. Has a doctor ever told you that it just takes longer to heal because you have Diabetes?…False!!…You need to leave it open to the air in order to dry out and make a scab?…False!!…Antibiotics are needed to heal that ulcer?….False!!
There are 3 things needed in order to heal a wound no matter where on your body that ulceration is located. You might think I’m crazy, but if you came to this website because you heard of me, than you also know that I am best known for my ability to heal foot ulcers. I know, shocking ..you were thinking it was my glowing personality or good looks, right? My own mother wouldn’t even say that. I am matter-of-fact, no hidden agendas type of guy. You need to know these 3 things needed to heal because it could save your leg.
The 3 Things Needed to Heal Any Ulcer:
- You need to have no infection
- You must have adequate circulation to heal
- There must be no pressure on the ulceration
Infection is when bacteria from your skin, yes from your own skin, travel into the open sore and start to grow. The reason I mention that the infection comes from your own skin is that treating your wound with antibiotics is not the answer. If you are infected, you need antibiotics, but not every wound is infected. Signs of infection include redness that does not turn white when you push on it with your finger, swelling, puss, and sometimes but not always pain. I diagnose infection by cutting out a small sample from the base of the wound after it has been thoroughly cleansed and submitting that for testing to see if bacteria are present. Using a cotton swab is not appropriate and leads to unjustified antibiotic use. There are no strict guidelines on the length of time you need to take antibiotics. In general for skin infection it is 10-14 days and for bone it takes much longer. Surgery may be needed to clear infection from your wound.
When we talk about your ability to heal we talk about the blood supply in your arteries. Peripheral vascular disease in patients with Diabetes is extremely common. If you smoke and have Diabetes, you are guaranteed of having peripheral arterial occlusive disease otherwise known as poor circulation. I can’t trust my ability to feel pulses in your feet because that is too subjective. Any doctor treating wounds will have a hand-held Doppler, which is a miniature ultrasound-like machine that allows us to listen to your circulation. Veins sound different from arteries and a blocked artery has different degrees of sounds. That is just basic screening done when I first see you. Other tests are often needed and will be arranged for you. Like I said above, I am have no hidden agenda and am very matter-of-fact. I have a team of physicians I use when circulation is questionable. I would like you to use these physicians because I have success when my patients see them. I’m sure your vascular surgeon is very competent, but that doesn’t mean they treat patients with foot ulcers. More often than not, I end up sending you to my team physicians after you have seen your favorite doctor and circulation has not been restored.
Without getting into too much detail there are 3 forces of pressure subjected to a wound no matter where it is on your body. Let’s keep it to the foot for this discussion. Vertical load is the pressure of your body weight on the foot ulcer. Friction is your skin sliding across a surface. Shearing is when your skin stays still, but the deeper layers move. Each of these types of pressure cause different signs so I can judge if they are still present despite my best efforts. Vertical load causes callous to form. Friction makes blisters. Shearing breaks blood vessels below the skin and causes bruising or dark discoloration. The most effective way to relieve all 3 of these forces is total contact casting. This is a specialized cast enclosing your entire foot to just below your knee. When total contact casting is used, you will be able to walk on the cast. Anything other than total contact casting is a compromise. I will allow you to make compromises in pressure relief in order to live your life the way you need to, but if the foot ulcer gets worse there will need to be a change.
Just 3 things to save your foot! It’s not easy to achieve all three of these, but if you come to Desert Foot Surgeons, it won’t be for a lack of trying.