Healing a wound can be like solving a puzzle and very challenging.  It is up to me to figure out why a wound won't heal or why it is present in the first place.  There are several reasons a wound won't heal, infection, poor circulation, uncontrolled diabetes, foot deformity, trauma and patient compliance.   I love wound care because it calls into play all of my training  in biomechanics, dermatology, infectious disease, primary care, medicine and radiology.  I feel that I am using the full scope of my education.  It is very rewarding to watch a wound evolve into "normal" skin.

In order to figure out what needs to be corrected to allow the wound to heal, I look at the wound from all angles.  I evaluate the circulation to see if there is vascular compromise.  If there is no flow, I refer to a vascular surgeon for intervention.  I test for peripheral neuropathy and loss of protective sensation. I look the nutritional status of the patient to see if the diabetes is under control or if there are any protein deficiencies that would delay healing.  I take x-rays and order MRI to evaluate for bone infection or abscess.  I look at structural deformities such as bunions and hammertoes.  Surgically correcting a hammertoe may relieve the pressure causing an ulcer.  I look at shoe gear to see if it is appropriate and may prescribe diabetic shoes and multidensity inserts.  Modifications such as a rocker bottom  may prevent ulcerations.  If there is a infection present I prescribe oral antibiotics or may have a patient admitted to the hospital for IV antibiotics. I consult with the infectious disease doctor to find the best antibiotic to treat the infection.   I must be acutely aware when a diabetic foot infection requires immediate surgical debridement or amputation.  It can make the difference between losing a toe or losing a leg.  Sometimes a patient may be in denial about their wound or diabetes.  Maybe a patient needs to make better eating choices, help monitoring their blood sugar or smoking cessation.  I can help refer them back to their primary care doctor for management.  Patients come in weekly for wound debridement.  It is also a good opportunity to ask how they are doing will their blood sugar and offer encouragement.  Chronic wounds may develop into a form of cancer and may need to be biopsied and surgically excised. If a wound has stalled I will use advanced therapy such as biologic grafts to faciliate the wound closure.    After a wound has healed I provide diabetic foot care to prevent future problems.     

There are several risk factors for developing a diabetic foot ulcer....

• Absence of protective sensation due to peripheral neuropathy
• Arterial insufficiency, poor circulation
• Foot deformity (hammertoes, bunions) and callus formation resulting in focal areas of high pressure
• Autonomic neuropathy causing decreased sweating and dry, fissured skin
• Limited joint mobility
• Obesity
• Impaired vision
• Poor glucose control leading to impaired wound healing
• Poor footwear that causes skin breakdown or inadequately protects the skin from high pressure and shear forces
• Kidney disease

What can you do to decrease your risk of a diabetic ulcer?

• Have your feet checked yearly by your podiatrist for signs of poor circulation or peripheral neuropathy, or more frequently if you already have these symptoms.
• Quit smoking
• Monitor blood sugar levels
• Exercise, stretch, lose weight
• Wear extra depth diabetic shoes with diabetic inserts prescribed by a podiatrist
• Hydrate skin daily with a moisturizing lotion
• Treat athlete's foot with an over the counter antifungal
• Check your feet daily, if you cannot reach your feet, use a hand mirror or ask a loved one to check them
• Call your podiatrist at the first sign of an ulcer, redness, drainage, swelling, foul odor.
• Don't be afraid to call a podiatrist if you don't have an established relationship with one.  Podiatrists consider ulcers to a "heart attack of the foot" and patients can be seen immediately.
• The sooner an ulcer is detected the easier it is to treat and heal.

Rheumatoid Arthritis

Most people with rheumatoid arthritis (RA) develop issues related to the foot or ankle. This inflammatory condition produces substances that inflame joints throughout the body. When RA affects the feet, it results in pain, stiffness, and swelling. Corns or bunions may develop, and toes can curl and assume a claw or hammer toe position. Foot bones may shift and cause the collapse of the long arch, resulting in flatfoot. Some of these issues can be addressed with surgery. Among the most successful surgeries is fusion, in which the cartilage is removed and the bones fused in place. A bone graft may be implanted to unite the bones.  Although loss of motion results, the patient achieves freedom from chronic pain.

HINT: Medication, exercise, and surgery can alleviate the eff ects of RA and may slow its progress.

Without proper early management of the feet, rheumatoid arthritis will slowly deteriorate the range of motion and flexibility of your foot. Take the road to happy, healthy feet and call us today. We treat all members of your family, from kids to grandparents, for all kinds of foot problems. Our phone number is 207-774-0028 We are a multi-faceted podiatric practice, offering conservative and surgical treatment of the foot and ankle. We are located at 15 Sewall Street, Portland, Maine. We provide personalized, friendly, caring and complete foot and ankle care. Specializing in custom molded orthotics to treat foot and ankle pain. 

Taken from the APMA website.  www.apma.org

Diabetes by the Numbers: Maine

The Prevalence of Diabetes in Maine

Diabetes is currently one of the ten leading causes of death in Maine. In 2009, 87,000 persons in Maine were estimated to have diabetes and the disease was estimated to affect the health of 8.3 percent of the adult population.1 Not only does diabetes cause detriment to the well-being of Maine’s citizens, but it also also puts a tremendous financial burden on the state.

The Cost of Diabetes

• The total cost of diabetes in Maine exceeds $776 million per year.2

• The American Diabetes Association estimates that a third of this cost stems from indirect costs such as lost work productivity, and that two thirds of the cost is a direct result of medical bills.

Complications from Diabetes

• $31,506: the average cost of each amputation.3

• In 2009, 216 non-traumatic lower limb amputations were performed in Maine due to the effects of diabetes.

• Diabetes is the leading cause of non-traumatic lower limb amputation; however, these amputations can be prevented. (This number does not include the number of toe amputations.)

Today’s Podiatrist Keeps Maine Walking

In 2010, nearly 72 percent of Americans revealed foot pain had prevented them from performing their daily activities, and visits to podiatrists have been linked to improved foot health. Research shows yearly visits to a podiatrist by those with diabetes significantly decreases the risk of lower limb amputation. Maine can benefit economically and medically from encouraging its diabetes patients to visit podiatrists yearly. For more information, visit www.apma.org.

1 “Maine Surveillance Data”. Centers for Disease Control and Prevention. http://apps.nccd.cdc.gov/ddtstrs/StatePage.aspx?state=Maine#Prev

2 “Combined State Sheets”. Juvenile Diabetes Research Foundation.

http://advocacy.jdrf.org/files/General_Files/Advocacy/2010/CombinedStateSheets4.05.10.pdf.

3 Healthcare Cost and Utilization Project.

http://hcupnet.ahrq.gov/HCUPnet.jsp?Id=A29E5D4893F8D9F5&Form=SelDXPR&JS=Y&Action=%3E%3ENext%3E%3E&_DXPR=PreRunP

CCDCC 

Talking the Walk

Exercise is good for you. However, caution must be taken when performing exercises that require repetitive motion, such as the treadmill. If the proper exercise techniques and the appropriate footwear are not used, low-impact foot injuries may result. Particularly for beginners, whose joints have not been developed, shin splints, Achilles tendon strains, and toe pain can result. When starting out, set the treadmill to a low speed. Be sure to stand straight, keeping your arms by your side. Move your feet in a sequence of heel-ball-toe.  If you need to, use the grips to maintain balance, but don’t let them support your weight. And be sure to wear good athletic walking shoes that off er suffi cient support and shock absorption.

HINT: Always stretch and warm up before exercising

Are you using a treadmill? Treadmill use increases the amount of repetition, and possibly lead to injury and potentially complicating common conditions like plantar fasciitis. (I am not a big fan of the treadmill for exercise.) You will receive the highest quality medical care coupled with the personal attention you expect and deserve. Our approach is conservative, gentle, and caring at 15 Sewall Street, Portland, Maine. We welcome your call for family foot care at 207-774-0028. We provide personalized, friendly, caring and complete foot and ankle care. Specializing in custom molded orthotic to treat foot and ankle pain.