Most wounds are the result of trauma, but can also result from ulcers in the neuropathic diabetic limb or be of a vascular origin. A traumatic wound is caused by a sudden trauma that interferes with the integrity of the layers of the skin. In a healthy person with good blood supply, this type of wound will follow a normal healing process.
Neuropathy is a disorder affecting the nerves and is a common complication encountered in diabetic patients. In a patient with diabetic neuropathy and unstable blood glucose levels, the process of wound healing can be altered, and wound can easily become chronic or infected.
With neuropathic ulcers, pressure points under the feet may become spots where ulcers, for instance, may well develop if there are not taken care of correctly through appropriate dressing or releiving.
This is a special problem as those patients often do not feel pain where a healthy person could easily do. Therefore, there may be delays before consulting, which greatly increases the risk of complications.
Arterial ulcers may occur in patients who have very poor circulation in the lower limbs. This type of wound is often painful, has the appearance of very focal necrosis and is usually located at the end of the toes. Your podiatrist will be able to evaluate the presence or absence and the quality of the pedal pulses by the use of a Doppler analysis.
In cases where insufficient blood flow is detected, the patient will be referred to a vascular surgeon for further analysis of the arterial blockage and receive appropriate medical and surgical care.
Wounds of venous origin occur when the venous system is impaired and when the venous flow does not properly return to the heart. This produces a venous stasis that involves a slowdown of the circulation. These type of ulcers are usually found around the inside area of the legs, near the ankles. This type of wound should be treated with proper dressings and support stockings in most eases. The initial step before starting any treatment is to receive the right diagnostic from your podiatrist. Afterwards, the follow-up until the end of the healing process is just as essential.
Charcot foot sometimes occurs in a diabetic neuropathic foot that has undergone a series of micro-fractures and subluxations over time where the foot ends up looking like a cradle. These bone changes are not necessarily related to injuries or accidents and are often painless. During the first stages of the Charcot progression there is severe redness and swelling of the affected foot.
This type of foot must be aggressively treated during the early phases of the disease to prevent further subluxations and subsequent deformities, which could create pressure points leading to the formation of ulcers under the foot that may also become infected. These deformities may be responsible for eventual problematic pressure points. Treatment requires complete immobilization of the foot. An accommodative orthotic will be needed to prevent ulcers at the pressure points caused by previous subluxations.