Foot Wounds: How to avoid them and how to treat them

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.

For more information, please visit our website at www,footnj.com

Diabetic Foot Care and Shoes

According to the American Diabetes Association, one in five people with diabetes end up at the hospital due to the foot problems.  Poor foot care can tragically lead to amputation of the foot or leg. To avoid this it is imperative that you learn proper foot care techniques and check your feet daily: top, bottom and in between the toes.

It is also important that you wear shoes at all times to protect them from injury.  Diabetic neuropathy of the feet may cause a loss of sensation and the patient may not even realize when an injury has occurred.

http://footnj.com/podiatrist-new-jersey-about-us/23/232-diabetic-foot-care-and-shoes

What precautions should I take to prevent injuries to my feet due to diabetes?

Washing your feet every day can help prevent serious health problems. Be sure to:

• Use lukewarm water and test the temperature with your hand before stepping in to make sure it’s not too hot!
• Completely dry your feet after washing, as infections like to form in moist areas such as between the toes.
• Soften skin with water-based hand and foot creams as dry and cracked feet often cause infections.  Do not place moisturizing creams in between the toes. Avoid oil and petroleum jelly as they actually dry the skin.

Other suggestions include:

• If you are a diabetic, controlled by diet or medication, you should never cut your own toenails. All toenail care and trimming of corns or calluses should be done by a podiatrist as recommended by the American Diabetic Association and almost all insurance companies.
• Quit smoking as it decreases oxygen and blood flow to the feet.
• Don’t cross your legs.
• Avoid sitting or standing in the same position for lengthy periods of time.

What types of shoes should I wear?If you are a diabetic suffering from peripheral neuropathy or circulation problems of the feet it is important to have shoes that are wide, soft, have high toe boxes as well as padded heels and tongues. Patients with reduced sensation or circulation wearing improperly fitting shoes run an increased chance of developing foot ulcerations and infections.

The federal government through Medicare has developed standards for a properly fitting diabetic therapeutic shoe. Shoe manufacturers submit their designs through Medicare for approval as a diabetic therapeutic shoe. For those patients who are diet or medication control diabetics, with symptoms of peripheral neuropathy or circulatory insufficiency, Medicare will pay for one pair of diabetic therapeutic shoe per calendar year as well as three pair of diabetic therapeutic insoles for the shoes.

Dr. Irina Tsyganova and her office staff can measure and fit patients who meet Medicare's standards of eligibility for diabetic therapeutic shoes. The shoes can be dispensed and picked up at Dr. Tsyganova's office. At that time, Dr. Tsyganova and her staff will make sure that the fit is proper.

Medicare provides for a diabetic patient with certain specific complications to be dispensed one pair of diabetic therapeutic shoes each year.  Medicare will pay for 80% of the cost.  If you have Medicare co-pay insurance, the company will pay the additional 20% leaving the patient with no out of pocket expense for the shoes. This is provided that all deductibles are met and that the patient has not previously been dispensed diabetic therapeutic shoes in the same calendar year.

All diabetics and patients with peripheral neuropathy or circulatory insufficiency should refrain from wearing shoes that will put pressure on bony prominences of the foot. Types of shoes to be avoided are shoes with high heels, pointy toes, thin soles and low toe boxes. In addition, these patients should avoid flip-flops and sandals because they provide very little protection from the environment.

http://footnj.com/podiatrist-new-jersey-about-us/23/232-diabetic-foot-care-and-shoes