Foot Ulcers: What To Do If You Have One
When using the term "ulcer", we are generally referring to a break or hole in the the skin. Ulcers are skin wounds can be slow to heal and are classified in four stages, according to which layers of skin are broken through. Stage 1 ulcers are characterized by a reddening over bony areas. The redness on the skin does not go away when pressure is relieved. The area is not an open sore, but the patient can be predisposed to having an ulcer at the site. Stage 2 ulcers are characterized by blisters, peeling or cracked skin. There is a partial thickness skin loss involving the superficial layers of the skin. Stage 3 ulcers are characterized by broken skin and sometimes bloody, watery, or creamy drainage. There is a usually complete loss of the skin along with some of the subcutaneous tissue, which includes the fat layer under the skin that holds the blood vessels and nerves.
Stage 4 ulcers are characterized by breaks in the skin involving skin, muscle, tendon and bone and are often associated with a bone infection called osteomyelitis.How an ulcer feels is dependent on the underlying cause of the ulcer. For example, one of the more common types of ulcers is seen in patients with diabetes, who have loss of sensation in their feet. In this type of ulcer, there is little if any pain, due to a condition called diabetic neuropathy. In fact, diabetics typically get this type of ulcer because they've lost their protective pain sensation. Another common ulcer is due to loss of arterial blood flow to the leg, resulting in ischemic ulcers that can be very painful. So you can see that it very important to have any break in the skin properly evaluated and the lack of pain is not always a good initiator as to the severity of the problem. There are many different diagnostic tests that can be done in the course of treating an ulcer. If the ulcer appears to be infected, and the patient has redness, drainage, swelling, and pain, then a culture of the wound should be done. The reason for the culture is to identify the type of infection, so that you can be put on the appropriate antibiotic. If there is suspicion of the bone being infected under the ulcer, the doctor will do x-rays and other imaging modalities to determine the extent of the infection. If there is suspicion that the underlying reason for the ulcer is poor blood flow, then a studies to look at you blood vessels can be done. Ulcers occur due to different reasons, so it is very important to determine the underlying medical problem that caused the ulcer. There are essentially four main reasons people get ulcers on the foot. Neuropathic Ulcers: This is when a patient has loss of sensation in the feet. It is commonly seen in people with diabetes but it can be caused by other reasons such as chronic alcohol abuse. These ulcers are generally seen under weight bearing areas and often will begin as a callus or a corn. Arterial Ulcers: This type of ulcer is due to poor blood flow to the lower extremity. This type of ulcer can be very painful and are usually found on the tips of toes, lower legs, ankle, heel and top of the foot. They can very easily become infected. Venous Stasis Ulcers: This type of ulcer is due to poor veins. Veins are the vessels that take fluid out of the legs and back up to the heart. Veins have small valves that allow blood to flow only one way, back up to the heart. The valves normally block the tendency for gravity to pull the blood back down to the legs. Sometimes the valves leak or cease to work at all. If the valves do not work, then the fluid pools down in the legs, causing swelling. This swelling leads to increase pressure in the venous system, producing discoloration of the leg and eventually this lead to ulceration. They are commonly seen around the inside of the ankle and are slow to heal. Decubitus Ulcers: This type of ulcer is caused by excessive prolonged pressure on one area of the foot. The most common place to see this type of ulcer is in a person confined to bed and they occur on the backs of the heels. The best thing you can do for an ulcer is to have it looked at by your doctor, as soon as you can. The earlier that the ulcer is treated, the better chance you have at healing it.The first thing that will be done is to inspect the wound. The doctor is looking for signs of infection, location of the wound, the color of the tissue in the wound. This is all done to determine the best treatment for that wound. Once the cause of the ulcer is determined and all the necessary referrals are made, treatment of the ulcer can begin. The treatment will be tailored to the individual ulcer and it is often difficult to predict how long it will take an ulcer to heal. Sometimes patients have to be referred to a vascular specialist if the ulcer is due to poor blood flow. Sometimes a patient has to be sent to their diabetes doctor to get their blood sugars controlled. It takes a careful thought process by the podiatrist to determine the underlying etiology of the ulcer and point the patient in the right direction.
The best prevention is treating the underlying cause of the ulcer. That means if you are a diabetic, check your blood sugar daily and inspect your feet every day. If the reason for your ulcer is due to swelling in the legs, then you need to wear support stockings and keep your feet elevated as much as possible. If the ulcer is due to poor blood flow, treatment may be rendered to get more blood flow and oxygen to your feet. If the ulcer is due to pressure, finding ways to relieve that pressure is required.
Dr. Eric Silvers and Dr. Kory Williams see ulcerations daily and are well trained to treat all foot and ankle conditions. They can be reached at 972-542-2155 or you may visit our website at http://www.advancedfoottexas
Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155
Showing posts with label Wound. Show all posts
Showing posts with label Wound. Show all posts
Wednesday, March 25, 2009
Wednesday, February 25, 2009
Proper Diabetic Foot Care Should Not Be Overlooked
DIABETIC FOOT CARE
As podiatrists (foot and ankle specialists), Dr. Silvers & Dr. Williams see a large amount of diabetic patients at their McKinney, Texas and Prosper, Texas Office Locations. These patients are usually referred from primary care physicians or endocrinologists, or patients themselves concerned about their foot health come to our clinic. Diabetic patients have to take extra special care of their to prevent ulcerations, infections, and even amputations. Listed below are a few helpful tips for diabetics concerned with how to take proper precautions and protect their feet. Take these steps to help prevent diabetic foot complications:
1. Check your feet everyday! This is an absolute necessity. If you can’t reach your feet, have a friend or family member check your feet. If needed, put a mirror on the floor and put your foot over it to look for cuts, scraps, bruises, openings or areas of irritation. Make sure you check between your toes. Very moist areas, white areas or red areas are bad. Check for foot fungus, patchy, scaly white areas between your toes or on the bottom of the feet. Check for irritated areas with redness or swelling. Check for infection. Redness, pus and drainage are signs of infection. Look for ingrown nails.
2. Check your shoes before you put your feet in them. Small pebbles or rocks can hide in the shoe. Put your hand in first and check it before you place your foot into the shoe. Items that I have found in patient’s shoes include socks, stockings, staples, rocks, legos and even a pencil. The most common response when I pull these items out of their shoe is “How did that get in there?”
3. Don’t walk around barefoot or in sandals. Splinters and needles can be hidden in the carpet and can puncture a foot without sensation. Punctures can go unnoticed. Unprotected feet can be more damaged when bumped or hit against furniture.
4. Watch out for folds in your socks. Believe it or not, small folds in the socks can lead to ulcers and infections. Rough seams in the socks can also cause areas of irritation that may lead to skin breakdown and ulceration. Avoid cotton socks and choose synthetic blends, polypropylene, acrylic, diabetic socks or small fiber wool blends.
5. Dry off your feet after showers and dry between your toes. Increased moisture between your toes can lead to the skin breaking down. This will eventually lead to an ulcer between the toes. Ulcers between the toes are very difficult to cure.
6. Don’t be a victim of fashion. High fashion shoes usually lead to a high number of problems in the feet. Make sure the shoes are wide enough. Don’t buy shoes that are too wide or too long which can cause a lot of slipping. Pick shoes that are soft and flexible and allow for cushioning on the top and sides, but are rigid on the sole. Make sure they don’t fold in half. You may be eligible for your insurance to pay for diabetic extra-depth shoes with custom insoles. These shoes will take the pressure off your feet. Ask your doctor.
7. Check your bath water with your hand before you put your foot in it. The temperature your foot feels is much different from the temperature your hand feels when you have neuropathy. Make sure to check the temperature with your hand. This will be much more accurate than testing the water with your foot.
8. Don’t use a heating pad on your feet. This may cause burns without you realizing it. This has specifically happened to my diabetic grandfather who in result had to receive repeated wound care and eventually a skin graft to bottom of his foot.
9. Do not use medicated corn pads or any medicated pads from the local drug store. These medicated pads are usually not effective and may cause a chemical burn on the surrounding skin. Don’t use any medication on the skin unless you are instructed to do so by your podiatrist.
10. Do not cut your own toenails. If you have loss of sensation or poor blood supply, make sure you have a podiatrist trim your toenails.
11. Do not trim your own calluses or corns. As mentioned above, if you have a loss of sensation or blood supply then have your podiatrist trim your corns or calluses.
12. Lose Weight. Easier said than done, but this is one of the most important steps you can take for your overall diabetes health and foot health. Your feet are not designed to carry that extra 100 pounds, that extra 50 pounds or even that extra 20 pounds. The more pressure on your feet, the more problems you will develop.
13. Exercise. Not only will exercise help you lose weight, contribute to your health, it will also help increase the circulation in your legs and feet.
14. STOP SMOKING! This applies to everyone, but especially to diabetics. Smoking causes the blood vessels to shrink. Smoking contributes to clogging of the arteries. Smoking also makes it more difficult for the nutrients in the blood to get to the areas they are needed. Diabetes + Smoking = Disaster.
15. Visit a podiatrist regularly.
If you have diabetes and are seeking treatment and advice, please come visit Advanced Foot and Ankle. Dr. Silvers is a board certified foot and ankle specialist practicing in McKinney, Texas and Proper, Texas. He sees patients from North Dallas, McKinney, Plano, Allen, Prosper, Frisco, Melissa, Anna and Princeton, Texas. To Schedule an Appointment with Dr. Silvers, please call 972-542-2155 or visit our website at http://www.advancedfoottexas.com
Dr. Kory Williams will be joining McKinney Foot and Ankle and Advanced Foot and Ankle in July of 2009. Both Dr. Silvers and Dr. Williams strive to deliver the utmost quality foot and ankle care with a compassionate bedside manner. Our doctors have 5 years of combined foot and ankle post graduate training and over 11 years of private practice experience. Both Dr. Silvers and Dr. Williams are respected speakers in the field of Podiatric Medicine, Surgery and Practice Management. Dr. Silvers is the Past President of the Dallas County Podiatric Medical Society.
Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155
As podiatrists (foot and ankle specialists), Dr. Silvers & Dr. Williams see a large amount of diabetic patients at their McKinney, Texas and Prosper, Texas Office Locations. These patients are usually referred from primary care physicians or endocrinologists, or patients themselves concerned about their foot health come to our clinic. Diabetic patients have to take extra special care of their to prevent ulcerations, infections, and even amputations. Listed below are a few helpful tips for diabetics concerned with how to take proper precautions and protect their feet. Take these steps to help prevent diabetic foot complications:
1. Check your feet everyday! This is an absolute necessity. If you can’t reach your feet, have a friend or family member check your feet. If needed, put a mirror on the floor and put your foot over it to look for cuts, scraps, bruises, openings or areas of irritation. Make sure you check between your toes. Very moist areas, white areas or red areas are bad. Check for foot fungus, patchy, scaly white areas between your toes or on the bottom of the feet. Check for irritated areas with redness or swelling. Check for infection. Redness, pus and drainage are signs of infection. Look for ingrown nails.
2. Check your shoes before you put your feet in them. Small pebbles or rocks can hide in the shoe. Put your hand in first and check it before you place your foot into the shoe. Items that I have found in patient’s shoes include socks, stockings, staples, rocks, legos and even a pencil. The most common response when I pull these items out of their shoe is “How did that get in there?”
3. Don’t walk around barefoot or in sandals. Splinters and needles can be hidden in the carpet and can puncture a foot without sensation. Punctures can go unnoticed. Unprotected feet can be more damaged when bumped or hit against furniture.
4. Watch out for folds in your socks. Believe it or not, small folds in the socks can lead to ulcers and infections. Rough seams in the socks can also cause areas of irritation that may lead to skin breakdown and ulceration. Avoid cotton socks and choose synthetic blends, polypropylene, acrylic, diabetic socks or small fiber wool blends.
5. Dry off your feet after showers and dry between your toes. Increased moisture between your toes can lead to the skin breaking down. This will eventually lead to an ulcer between the toes. Ulcers between the toes are very difficult to cure.
6. Don’t be a victim of fashion. High fashion shoes usually lead to a high number of problems in the feet. Make sure the shoes are wide enough. Don’t buy shoes that are too wide or too long which can cause a lot of slipping. Pick shoes that are soft and flexible and allow for cushioning on the top and sides, but are rigid on the sole. Make sure they don’t fold in half. You may be eligible for your insurance to pay for diabetic extra-depth shoes with custom insoles. These shoes will take the pressure off your feet. Ask your doctor.
7. Check your bath water with your hand before you put your foot in it. The temperature your foot feels is much different from the temperature your hand feels when you have neuropathy. Make sure to check the temperature with your hand. This will be much more accurate than testing the water with your foot.
8. Don’t use a heating pad on your feet. This may cause burns without you realizing it. This has specifically happened to my diabetic grandfather who in result had to receive repeated wound care and eventually a skin graft to bottom of his foot.
9. Do not use medicated corn pads or any medicated pads from the local drug store. These medicated pads are usually not effective and may cause a chemical burn on the surrounding skin. Don’t use any medication on the skin unless you are instructed to do so by your podiatrist.
10. Do not cut your own toenails. If you have loss of sensation or poor blood supply, make sure you have a podiatrist trim your toenails.
11. Do not trim your own calluses or corns. As mentioned above, if you have a loss of sensation or blood supply then have your podiatrist trim your corns or calluses.
12. Lose Weight. Easier said than done, but this is one of the most important steps you can take for your overall diabetes health and foot health. Your feet are not designed to carry that extra 100 pounds, that extra 50 pounds or even that extra 20 pounds. The more pressure on your feet, the more problems you will develop.
13. Exercise. Not only will exercise help you lose weight, contribute to your health, it will also help increase the circulation in your legs and feet.
14. STOP SMOKING! This applies to everyone, but especially to diabetics. Smoking causes the blood vessels to shrink. Smoking contributes to clogging of the arteries. Smoking also makes it more difficult for the nutrients in the blood to get to the areas they are needed. Diabetes + Smoking = Disaster.
15. Visit a podiatrist regularly.
If you have diabetes and are seeking treatment and advice, please come visit Advanced Foot and Ankle. Dr. Silvers is a board certified foot and ankle specialist practicing in McKinney, Texas and Proper, Texas. He sees patients from North Dallas, McKinney, Plano, Allen, Prosper, Frisco, Melissa, Anna and Princeton, Texas. To Schedule an Appointment with Dr. Silvers, please call 972-542-2155 or visit our website at http://www.advancedfoottexas.com
Dr. Kory Williams will be joining McKinney Foot and Ankle and Advanced Foot and Ankle in July of 2009. Both Dr. Silvers and Dr. Williams strive to deliver the utmost quality foot and ankle care with a compassionate bedside manner. Our doctors have 5 years of combined foot and ankle post graduate training and over 11 years of private practice experience. Both Dr. Silvers and Dr. Williams are respected speakers in the field of Podiatric Medicine, Surgery and Practice Management. Dr. Silvers is the Past President of the Dallas County Podiatric Medical Society.
Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155
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