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Next Step Foot & Ankle Clinic

How to Heal a Pressure Ulcer or Diabetic Wound

“Hi, this is Dr. Silvester and I’m going to talk to you a little bit today about why I think you should come to see us if you have a diabetic foot ulcer.

I had an experience two months ago when a gentleman came to see me who had been to a wound care center for about a month and a half and had been seeing another podiatrist for about a month. He had been told that he needed to get his first toe amputated because they were afraid that he had a bone infection.

This is a typical patient who comes to see us quite frequently – one who has diabetes, has had an ulcer and dealt with it for a long time without any success. The patient came in to see me and it may be that he has a bone infection (they can be difficult to diagnose in some cases), and we put him on a treatment therapy. One of the primary treatments we put him on was getting pressure off the wound. The mistake that I see most wound care centers and other doctors make is that they are treating the wound. The problem with treating the wound is that the wound is not the problem. The wound is A problem, but the problem is the pressure caused by some other biomechanical function or by some bone putting pressure on the area where the ulcer forms.

The gentleman who came in to see me had this condition. We put him in a cast that took pressure off the wound, and almost immediately all of the redness went away and the ulcer began to shrink. We gave him some IV antibiotics and were able to clear up the infection. As soon as the patient got the cellulitis, or infection, down we didn’t let him return to shoes or put pressure on the foot in the same way. We immediately took him to surgery and we fixed the two components that were putting pressure on the ulcer.

The patient went through the recovery with no problem and was able to get back in shoes and the foot stayed closed. 

The other patient that we see quite frequently is a patient who has had a diabetic foot ulcer and goes through elaborate and expensive wound care, gets the wound healed, but then three weeks later, when he returns to his normal shoes, the ulcer starts coming back. That is because they’re not addressing the cause of the problem.

It’s like having a flat tire. If you have a flat tire, the most important thing is to fix the leak. If you don’t fix the leak and just keep putting the air in the tire, it’s going to be an ongoing problem. What we try to do, with our understanding of biomechanics, surgical offloading, offloading with shoes and total contact casts, is “fix the leak” in the same time as we’re addressing the “air in the tire”.

That’s why I think it’s important for people who have a diabetic foot ulcer to consider seeing us so that we can address the cause of the ulcer initially and thereby, hopefully, prevent future breakdown and ongoing problems & difficulty in healing the wounds. For example, in this gentleman, who’d had a wound for six months, within a week after he had his surgery, his would closed completely and it hasn’t opened up since.

That’s something to consider, I appreciate you listening. Thank you!”