Diabetic foot ulcers are open sores or wounds commonly located on the bottom of the foot. Ulcers can result from a loss of feeling (numbness) and/or decreased circulation in the foot.

Feeling pain helps protect the skin from injury. Diabetics with loss of feeling often develop blisters from shoe pressure or notice blood on a sock because of a roofing nail in their shoe. It's extremely important for all diabetics to inspect their feet daily for signs of irritation following a basic diabetic foot care protocol.

The skin is a natural protective barrier against infection. Once open it can allow bacteria into the body resulting in an infection. The infection can destroy tissue such as tendon and muscle and eventually invade bone. Diabetic foot ulcers are often much deeper than they appear on the surface. They are serious problems and require profesional care.

In the absnce of systemic symptoms such as high fever or severe infection, most diabetic ulcers can be evaluated and treated in an office setting. Regardless of how the diabetic ulcer is treated, there are four basic requirements for healing: pressure against the ulcer must be removed, infection must be identified and treated, adequate blood supply and time.

Poor Circulation

Cold toes accompanied by pain can be a sign of poor blood flow to the foot. The risk increases with diabetes, Raynaud’s Phenomenon, Buerger's Disease, high blood pressure, heart disease, hypothyroidism or anemia. Smoking aggrevates the problem.

Loss of circulation often leads to a breakdown or ulceration of the skin. Arterial ulcers are usually very painful and can result in bone infections (osteomyelitis) requiring possible amputation.

Raynaud's Phenomenon

Raynaud's Phenomenon often is seen in woman with the toes, fingers, ears and nose changing color when exposed to cold, trauma (injury), or emotionally stressful conditions. Color changes include the toes turning white, then bluish, and then red before returning to their natural color. The cause is a sudden narrowing of the arteries, called vasospasm. Raynaud’s can occur with rheumatoid arthritis, Sjögren’s disease, or thyroid problems.

Arterial Sonogram

An Arterial Sonogram is an in-office, non-invasive, painless exam indicated for Diabetics over age 60 and patients with known peripheral arterial disease (PAD). The test can identify narrowing, calcification (plaque) and possible occlusions (clots) in arteries of the legs.

Varicose Veins

A Venous Sonogram is an in-office, non-invasive, painless procedure indicated for patients with symptomatic varicose veins or Chronic Venous Insufficiency. The exam is used to determine the severity and location of the problem and the best course of action.

Over time chronic venous insufficiency can cause swelling, redness, pain and clots (phlebitis). The skin in the leg above the enlarged vein becomes discolored, swollen and painful. The discoloration is caused by red blood cells leaking from the enlarged veins. The red blood cells release iron which stains and irritates the skin which breaks down forming a venous ulcer.

The most common site for venous ulcers is on the inside of the ankle. Venous ulcers are usually treated in the office with application of special bandages, allographs and possibly venous ablation. Venous ablation is a safe and effective procedure designed to "close" the surface veins. Under ultrasound guidance the procedure is performed in the office. Follwoing the procedure most venous ulcers heal and patients can quickly resume their normal life style.

Lymphedema

Lymphedema is a build-up of lymph fluid in the fatty tissues just under your skin. This build-up often occurs in the legs and arms causing swelling and discomfort.

Lymphedema can sometimes become severe and cause serious problems such as scarring in the skin with leakage of a clear fluid from under the skin. Secondary infections in the skin can occur. Early diagnosis and management helps reduce symptoms and keeps the problem from getting worse.

Treatment of mild to moderate lymphedema usually involves the use of custom fit compression stockings. In more advanced conditions at home compression devices coupled with custom fit support stockings can be affective.

Sores That Don't Heal

Sores on the leg or foot that will not heal can be a sign of skin cancer. More common problems include squamous cell carcinoma, basal cell carcinoma and melanoma. Many of these problems can be treated in the office depending on the diagnosis and size.

A biopsy is recommended for skin ulcers not responding to conventional treatment. The procedure includes taking a small sample of the tissue to be examined be a pathologist. The biopsy can usually be performed in the office to determine a course of treatment.

     

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