Diabetic Foot Wound

Foot InjuryIt is no secret that Diabetes is at epidemic levels in our country. I run a clinic specializing in Diabetic foot and ankle wounds and thousands of foot wounds every year. Why does Diabetes effect the feet? Although this answer could be very lengthy, essentially, elevated blood sugars effect every function of our bodies. What most people don´t know is that elevated blood sugars over time (sometimes 10 years), damages the nerves in the feet making them "numb". So numb, in fact, that literally a "neuropathic" person could step on a nail and not feel it. Happens everyday. This also means that even a simple callus on the bottom of a foot can cause a significant problem. A callus can act just like having a pebble in your shoe all day long. What would happen? A wound. Now this wound is exposed to the environment where bacteria exsists and therefore the possibility of infection. This can literally happen in a single day and require surgical debridement or even amputation.

Now, let´s add impaired circulation. Typically, a wound anywhere on our body requires an increase in blood flow to the area for adequate healing. Diabetes can lead to a decrease in circulation (to the foot especially) and therefore poor healing potential. After all, the foot is the furthest from the heart.

CastSo we have covered two of the basic issues leading to a Diabetic foot wound - neuropathy (electricity) and circulation (plumbing). So, in a diabetic body (the house) we have faulty electricity and plumbing. Add damage to the foundation (the feet) and we have problems. For instance, a bunion or hammer toe, will produce a bony prominence on the bottom of the foot. This prominence creates an increase in pressure at that point, much like a high heeled shoe has very high focal pressure at the heel. This is where a callus would form to try to protect the area. If you have good sensation, you pad this area or change the way you walk to avoid it. If you can´t feel it, the callus grows and becomes that "pebble" in the shoe.

So, how do we treat a diabetic foot wound and prevent the amputation? Easy, get off of the foot. Pressure and shear created the wound so just reverse the process right? Most people with a diabetic foot wound are older people that have difficulty getting around with two feet. So take one away with crutches or a wheel chair and we complicate the matter. However, the Gold Standard of treatment of an insensate (neuropathic) wound on the bottom of a foot is the Total Contact Cast. This is similar to a cast for a broken leg with the exception of how it is applied and with specific materials. This cast or TCC, can effectively be the "crutches" needed to off-weight the bottom of the foot while allowing the person to continue to walk and heal the wound. It has been very well studied and shows that its use can heal a wound in about 44 days. This is not a new technology. It has been around since the 1960´s. This cast has proved to heal a wound on the bottom of a diabetic foot in a matter of about 43 days.

The Total Contact Cast is applied in your Podiatrist office and is replaced on a weekly basis in order for the doctor to evaluate and treat the wound routinely.

 

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