Ulcerations

There are many different types of wounds that may appear on the foot and/or leg. The most common ones seen by podiatrists is a diabetic wound, which are caused by neuropathy (which is damage to the nerves, [see earlier blog on diabetes]). Many of these patients do not feel their feet, and therefore, present to a physician with an infected wound. Other types of common leg wounds are pressure wounds, the most common location being the back of the heel. These types of wounds would be found on bed bound patients. Another common type of leg wound is an arterial wound which is caused by Peripheral Arterial Disease (see earlier blog for more on PAD).  Another leg wound is a venous wound, when the veins in the legs don’t work properly and a wound develops on the inside of the lower leg. Despite what type of wound one has proper wound care, in addition to close supervision by a trained physician in the field of wound care is critical to healing wounds.

Why are wounds so hard to heal?

Many times wounds are not treated until they are large in size. Many people with wounds many attempt, with good intentions, to treat the wounds by themselves. Usually wounds need to be treated with a multi team approach, including podiatrists, vascular surgeons, plastic surgeons etc. Many wounds tend to take a long time to heal due to other underlying medical conditions. For example, a diabetic wound can take a while to heal due to poor control of blood sugar, peripheral neuropathy and possible lack of circulation. Once all these issues are addressed the wound may have become chronic. In addition, wounds that are caused by arterial or venous disease need close supervision and many times surgery by a vascular surgeon. Without enough blood flow a wound will not heal. Many wounds that are caused by the venous disease take a long time to heal due to severe leg swelling, known as lymphedema. If the swelling is not controlled the wound will not heal.

Where do I seek treatment for a wound?

The best place to seek treatment wound be a wound center. Many hospitals around the country have a wound healing center, which employ the necessary multi specialties to help with wound healing. Internists, Infectious Disease Specialists, Podiatrists, Vascular and Plastic Surgeons are the type of physicians that wound work at a wound center. Many wound centers contain Hyperbaric Oxygen chambers, which are machines with high levels of oxygen, which help accelerate wound healing. In addition, there are many specialty, advanced wound care products, dressings and grafts, that can only be found at wound centers.

How Can I prevent a wound?

Patients that are high risk for wounds include diabetics with neuropathy, people with PAD, people with severe varicose veins with swollen legs, people with sickle cell etc. These patients should carefully inspect their feet daily to make sure there are no small cuts or openings. On the first site of an open lesion they should contact their physician. In addition, if a patient has an area on their foot that many be more prominent and perhaps be a pressure point, proper orthotics and offloading shoes can be dispensed by a podiatrist.