About Wound Care

Dr. Young addresses diabetic wound care through a multidisciplinary approach. Wounds develop often in the presence of peripheral neuropathy. They may be complicated by deficiency in circulation. Having an evaluation of the nervous system and circulation is always considered and testing may be ordered. A person's hygiene, their lifestyle and occupation stresses, even their nutrition are involved in the ability to heal from a wound.

A history is taken noting prevous foot ulcers, infections and treatments. Foot deformities like bunions and hammer toes and callouses can lead to ulcerations of the skin. Your daily activitiers, work duties, the shoestyles you wear, glucose control and nutrition are assessed.

Wound care is initiated and evaluated at each visit. Treatment plans are made for the individual and changed according to the wound's response to treatment.

Xrays, Labs, Mri or CT swcans may be ordered to evaluate for infections. Circulatory evaluation (pulses, Doppler tests, color, temperature and edema).

Recommendations for patients with diabetes:

-- Wash your feet daily and dry thoroughly including the toes.
-- Look at your feet daily. Use a mirror in good light or ask for help
-- Moisturize your skin to prevent cracks
-- Wear socks
-- Your shoes should be supportive but give room for toes and wide enough at the ball of the foot. Leather is best. There should be adequate cushioning.

Diabetic foot problems are notorious for being limb threatening. Improvements inmany areas are changing this.
-- advances in the care of diabetes mellitus and awareness and acceptance of the importance of nutrition and exercise.
-- Education of patients in the improvement of foot care
-- Patient and physician awareness that early treatment of foot problems can make a big difference.
-- When complications such as ulcerations occur, the quality wound of wound care is improving. Far beyond simple ointments and gauze, the newer wound care products and dressings aid in accelerating healing, not just treating but preventing infection. Even skin replacement dressings or grafts are now being used to speed healing. This helps to return one's lifestyle and prevent amputations, as well as better contain medical costs.

Edema, swelling in the feet may mean several things. These include medications, heart or kidney failure, lymphedema. Local foot problems may include an ulceration, infection, abscess or breakdown of the joints of the foot.

Absence of hair, color changes (pale or pink), are found as circulatory problems.

Callouses and corns should be removed periodically by a podiatrist to prevent infection and ulcerations. Don't do this yourself. While we are treating your nails and callouses, evaluation of your feet, reassessment of your deformities are also being performed. That way serious problems may be avoided. ‘'

We participate in Medicare's Therapeutic Shoe Program. This excellent program developed from research showing that well made leather shoes with adequate support, toe room and cushioning can prevent serious foot complications from diabetes.

Weakness in the legs, numbness or pain in the feet, or balance problems are
associated with neuropathy. It is important to test for and monitor peripheral neuropathy. There are several medications for peripheral neuropathy.

Healing from a wound requires good nutrition that includes fruits vegetables and water. There is a growing interest in wellness concepts. Good quality health begins with basics. Alternative treatments are interesting to consider. But it is always prudent to consider the science behind these alternative methods of treating.

The Weintraub study (Static magnetic field study for symptomatic diabetic neuropathy: a double blind placebo controlled trial; Michael Weintraub et al; Arch. Phys. Med. Rehab. Vol. 84, May 2003) evaluated the effect of Nikken magnetic insoles on the diabetic neuropathy. This is a valid study (double blind placebo controlled). Results were significant improvement in severe pain, burning and numbness.

Patients often suffer from cold feet and legs. Sometimes they are told it is poor circulation but are rarely offered any help. Consider fabric that reflect far infrared energy. Nikken has socks, comforters, even beds that have this comforting material that was developed by NASA for the astronauts suits. For more information, go to www.nikken.com/footwellness and read the research on magnetic and infrared technology as well their other products. Nikken is the largest wellness company in the world with the original concept of a Wellness Home. Read about it. Then decide.

Healthy relationships even a couple makes a difference in your foot health. Having people in your life whom you care for and who care about you raises your expectations for a healthy life. Being happy makes it easier for you to take care of yourself including your feet.

Once an area has had an ulceration it has scar tissue. The scar tissue is never quite as good or as pliable as the pre-diabetic state. It is easier to develop an ulceration again. It is essential to address and correct the contributing causes.

Healthy Diabetic Foot: Preventing Tragedy

1. The most important goal is intact skin.
2. Wear shoes that fit well and give cushioning and support
3. Wash your feet and inspect them.
4. Early treatment of blisters and cuts

Periodic visits with a podiatrist or physican skilled and interested in early detection and treatment of foot deformities and infections in diabetic patients. Letting problems go, or” keeping an eye on it” is not the current recommendation by the American Podiatry Association or the American Wound Care Association.

Strict control of your diabetes. Listen and follow your doctor's diabetic regimen. Take your medications. If your blood sugar is hard to control, consider an infection somewhere.

Take care of your eyes. Your eyesight is important even for the well being of your feet, your lifestyle, nutrition and exercise. Period exams to an opthmalogist is important.

Your dental health is important for nutrition. Even heart problems havge recently been associated with dental health. If you don't eat well, especially fruits and vegetables, you will not have optimal health and healing.

What happens when you have an ulcer? What is the treatments?

1. Debridement to remove dead tissue and callouses. This helps to start healing.
2. Evaluation of the wound bed and describing the ulcer.
3. Evaluation of the circulation: a Doppler may be ordered.
4. Topical wound healing agents, dressings
5. Grafting with skin substitutes may be applied to close the wounds quickly
6. A deep abscess requires hospitalization and sometimes surgical debridement.

Working with your primary care physician is always included.

Debridements: periodic, enzymatic, mechanical, surgical
Wound Dressings: provide protection. They podify the wounds physiology and stimulate healing. Growth factors are released by some. Most try to inhibit substances that slow down healing.

Newer technologies include plasma gels made from your own blood and speed up healing. Negative pressure wound thereapy removes edema from the wound and bacteria. It also enhances the formation of new blood vessels and provide oxygen. It is often used for exposed tendon, bone and hardware.

Pressure Relief and off loading is essential to treatment. It prevents further damage to the tissue and helps with wound healing. Without sensation micro trauma from simply standing and walking or shoe pressure can cause skin breakdown an infection. The patient does not suspect a problem until it is severe.