Foot ulcers are a result of neuropathy (loss of feeling) and repetitive pressure (walking). Ulcers usually start as a callus and then proceed to a blister with or with out blood, then the skin sloughs off to reveal an ulcer. Foot ulcers in diabetes are usually painless which causes people to delay treatment. Foot ulcers are the leading cause of amputation in diabetes and need to be treated aggressively.
In order to close a foot ulcer, we must ensure there is no infection and adequate circulation. Ulcers over 3 months may contain cancer cells and a biopsy is often performed. Then we concentrate removing pressure from the foot, sometimes using special casts so that you can still walk while your treatment is ongoing (FIGURE OF TCC). For deep wounds, a vacuum suction device is used to bring the blood flow to the surface and regenerate tissue. If wounds don’t respond to treatment quickly, we use grafts made from placenta, baby foreskin, pig intestine, or cow tendon to cover the wounds. These grafts help us to cover exposed bone or tendon, or may just provide growth factors to the wound to speed closure. In some cases, we use a skin graft from your thigh, either in the clinic or in the operating room to close your wound.
Foot infections are emergencies. People with diabetes have impaired ability to fight infection and it can spread rapidly and lead to limb loss or death. The signs of a foot infection are redness, warmth, odor, or pus coming from a wound. People with foot infections are often admitted to the hospital, placed on IV antibiotics, and may need surgery to control the spread of the infection. After the infection is controlled, we treat the defect to heal the wound.
One of the more common complications of diabetes is vascular disease, or impaired circulation. If the blood flow is below the level required to supply the tissue, it may die and cause gangrene. If this reduced circulation causes gangrene or impedes wound healing, vascular surgery may be needed. Restoring blood flow is accomplished by either a wire and a balloon inside the artery, or with a bypass surgery.
Charcot foot is commonly misdiagnosed or missed completely. It occurs as a result of neuropathy and usually trauma. The bone become soft and they may dislocate and the arch my collapse. The foot is usually swollen and hotter than the other foot. This leads to unusual pressure on the bottom of the foot which may cause an ulcer. In early stages, a cast may be all that is needed to put it into remission. In more advanced cases, surgical reconstruction is needed. At the Amputation Prevention Center®, we utilize external ring fixation, which is like a scaffolding for you foot, to hold the bones back in place. The fixator, or halo, is used for about 3 months.
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