wound care

--> wound care



Within the last 15 years or so, wound care has become a specialty all onto itself. I do not have any hard facts to support the following statement, but the foot probably demonstrates the highest incidence of wounds more so than any other part of the body. Additionally, the foot has obstacles in treating wounds that is not seen elsewhere in the body. The two most obvious obstacles are the fact that circulation to the foot in many cases is compromised and by walking on the foot (and the wound), the healing process is greatly diminished.

Podiatrists have become the leaders in the local management of wounds. Most wound care is done in a team approach, meaning other medical specialties get involved, but the day to day care of the wound falls in the hands of the podiatrist.

For those who suffer from wounds of the foot the healing process can end up being a long drawn out process; in some cases a wound never heals and with a chronic wound the patient is always at risk for infection and loss of limb. Wound care in the foot is a complicated procedure, there is no one approach. Each wound is different and requires different treatment. The purpose of this article is to help those who are presently suffering from a wound of the foot in understanding the wound care process. Hopefully, what you read here will reinforce what your doctor has told you and you as the patient, will be more compliant in the instructions you have already been given.

can I walk on my foot wound?

ulcer with granulating base
Invariably when I attend a wound care conference, at some point, one of the speakers will say the following: "when it comes to wound healing it is not so much what you put on it (medication and dressing), but rather what you keep off of it (non-weightbearing)". What this means, and this is very important, is the more you walk on a wound on the bottom of your foot, the longer it will take for the wound to heal. So, when no one is around and you start walking on the wound because it is just easier than using your crutches or special boot, the only person you are hurting is yourself. There is no two ways about it, a wound on the bottom of the foot is going to adversely affect your every day lifestyle. The gold standard for off-loading a wound is through the use of a contact cast. Sometimes cam walkers may be used along with special surgical shoes and in some cases your doctor will just want you using crutches. The decision as to what type of off-loading to employ is based on a few factors including location of wound, weight of the patient, physical capabilities of the patient, etc.

For those of you who are suffering from a wound on the bottom of your foot, you probably noticed that prior to the wound you may have had a callus or hard spot in the area that the wound now occupies. What happens is due to too much pressure on an underlying bone, the body will normally form a callus in varying thickness. The thickness will be determined by the overall foot structure of the patient, their overall body weight, the types of shoes they wear and the walking surfaces where they do the most walking. All things being equal, a letter carrier would stand a greater chance of developing a foot wound than someone who sits at a desk all day.

factors that contribute to wounds on the bottom of the foot

Due to a lot of variables such as:

  • lack of sensation on the bottom of the foot
  • poor circulation to the foot
  • elevated blood sugars in an uncontrolled diabetic
  • poor foot hygiene
  • improper shoes
  • excess body weight
A callus on the bottom of the foot will begin to first thicken and then at some point will break down and become a wound.
ulcer with granulating and fibrotic base
Many of you reading this will remember that prior to the development of your foot wound, your doctor may have given you a warning on the proper care of your feet. You may or may not have complied, however, sometimes even with good patient compliance a wound may still form.

As I mentioned earlier, not all wounds are the same and so wound care will differ from person to person. For this reason the medication used for wound care will also vary from patient to patient. There is no one topical medication that is effective for all types of wounds. The purpose of these different types of dressing is to create an optimum environment for wound healing to take place.

four categories of wound care dressings

calcium alginates- The first group is known as the calcium alginates. An example would be Silvercel which are very absorbent. Many wounds present with a lot of drainage. In order to create the optimum environment, the wound has to be dried out to some extent, and Silvercel will absorb the moisture to form a gel. This type of dressing is changed frequently and is used until the wound is much less moist but not completely dried out.

foams- The next classification of dressing are known as foams. They too are used to treat heavy draining wounds and the nice thing about this type of dressing is that they will not stick to the wound and can be left on longer than the calcium alginates. An example of the foams is Polymem.

collagens- The next group are known as the collagens which are also absorbent and will not stick to the wound. In addition to pads they also come in powders. They can be packed into the wound and are used for infected wounds. A point to be made here is that all infected wounds will have drainage, but not all draining wounds are infected. That is an important distinction and that will explain why some patients are put on antibiotics either oral or intravenous and other are not put on antibiotics. An infected wound will have certain characteristics and in this day and age it is important to avoid the indiscriminate use of antibiotics which in the long run lessen the effectiveness of antibiotics in general.

ulcer with fibrotic base
hydrogel dressings- The last group of dressings are known as hydrogel dressings. Possibly the most popular is Amerigel. This is used when there is either little drainage or no drainage at all, all the way to a very dry wound. What these actually do is create a moist environment. Sounds contradictory doesn't it? Actually, wounds that are too dry are just as difficult to close as are wounds that are draining too much. Again, it is all about creating the optimum wound environment, which is a moist wound that is not draining. Years ago betadine was the standard for treating wounds and while betadine is great at killing bacteria it dries the wound out so much that there is virtually little chance of the wound closing. Betadine still has a place in wound care and it is usually used when the patient first presents with a heavy draining wound, but once the wound shows signs of reduced draining, the dressing should be switched to another type dressing.

With all the above dressings the frequency with which they are changed will vary from patient to patient and is based on what your doctor is trying to accomplish. A dressing that has a tremendous amount of drainage, may initially have to be changed daily until the drainage diminishes at which point the dressing change will be less frequent.

evaluating your wound

During your visit to the podiatrist, he or she will generally first observe the wound. The things that are important to note include the diameter of the wound and the depth of the wound and usually your doctor will measure these at each visit. Obviously a reduction in width and depth shows that the wound is improving. The doctor will also note what the base or bottom of the wound looks like. A good healthy wound with adequate blood coming into the area should appear beefy red. This is known as a good granulating base meaning all the components are in place for healing. Sometimes, however, the base of the wound will be greyish to yellow in color and this is a sign of a poor granulating base and thus the chances of closure are dramatically reduced.

decubitus ulcer

Your doctor will also make note of the edges of the wound. In many instances the tissue around the wound becomes very hard. Again, the more you bear weight on the foot, the harder the surrounding skin will become. The problem here is that this skin which is known necrotic skin not only makes closure of the wound difficult but it is a focal point for bacterial infection. Once your doctor is done observing the wound, he or she will usually debride (cut away) all this necrotic tissue in an effort to once again create an optimum wound healing environment. Depending on the type of wound, most of them can be debrided in an office environment, however, some wounds such as very dry ulcers may be too painful to debride and will have to be done in the hospital under sedation. As a side note, if there happens to be a lot of bleeding, that is actually a good thing as it demonstrates that adequate blood is coming into the wound.

What I have discussed so far is the basic management of wounds, at least on the foot. However, in many instances this may not be enough to get the wound to close. At this point, and this point being where your doctor has noted that there has not been any substantial improvement in the size of the wound over a month or two. The rule of thumb is if the ulcer size has not decreased by 50 percent in this period of time, then chances are it will never close without additional treatment approaches.

continue....wound care








download from Apple Store
Get it on Google Play

ORTHOTICS for multiple types of foot pain
best buy in a pre-made orthotic
click link below


SuperStepOrthotics


ORTHOTICS for heel and arch pain for those who must wear dress shoes
click link below


redithotics


Topical pain reliever
click link below


blu-mjk


Relief for nail fungus
click link below


clotrimazoil





I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis.

Jennifer

Hunterville, NC


….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!

Liesbeth

NY
I am really, really impressed with your plain-speak explanations for the various conditions.

Jacqueline

NJ
This was an extremely helpful site. I have an appointment on the 18th and your info. Was right on target…..

Jack

Fla
A well organized site containing much information written in a manner that the average reader can comprehend.

Jean

Ontario, Canada
I found your website and articles most interesting.

Andrew

Fla.
Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.

Judy

(location unknown)
I came to your website, footspecialist.net via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.

L.W.

New York
You have an amazing and extremely informative site. I enjoyed looking through all of the data and stats.

Yvette

Memphis, TN
Thanks again so much for the information in the article. Very interesting.

Anna

Scotland
Great article. I have had plantar fasciitis since I was in high school……..

J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Tennessee
Thanks for the Response, you hit it on the head.

Steve

Redondo Beach, CA
Thank you for your time and expertise in answering my question…..

LH

(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….

Joe

(location unknown)
First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.

Pete M.

(location unknown)
Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....

Carol

Denison, TX
Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,

Dawn

West lafayette, IN
Dear sir...no doubt you get positive comments re your site...May I please be added to the list of your admirers. In all of my years of web surfing I would say your site is right there with the very best. Thank you for taking the time to write the terrific info you provide and for putting things into laymen terms for us mere mortals. I pray you have much on going success and thank you again for a deed well done. As for me I did not find much help for my symptoms and will continue on my quest. Were you anywhere in the South I would make and appointment...Thanks again dear sir...m.e.

Michael E.

Tampa, Florida 33624
Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....

Kelly

Texas
Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624


Thanks for a most interesting website, which has helped a lot.

Steve

UK


Dear Dr.Mitnick

I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.

I thank you for putting together this incredible website.

Regards,

Dragica W.

Edmonton,Canada


....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!

Roxy

South Africa


You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT


First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.

Steve

Placentia, California


First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)

Unknown

Unknown location


I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location


I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA


I used to work for a podiatrist (front desk) back during summers in college years ago, so I know the benefits of good care. Again, I want to thank you for an EXCELLENT website. It was so great to get to your site (top of google search) and actually find all the answers I needed EASILY and QUICKLY! Clearly you put a ton of work into it and I really appreciate it.

All the best,

Victoria

Alameda, California


By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!

Anonymous


Thank you for your very interesting and informative site!

Anonymous




Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN


Thanks very much for the wonderful informative site.

Catherine

New Zealand


Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!

Sincerely

Josette


Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

Arizona
I searched the internet everywhere for a clear description and illustration of my symptoms/problem. http://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

Florida
1st of all THANKS A LOT for your great site......

Anna

Poland
Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!

M P

South Carolina
Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....

Natalie

unknown location


...Thanks for your fantastic service.

Gary

Arlington, VA


Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA


Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!

Pam

location unknown


Great insights! Thanks Doc, you're the best.

Glen

location unknown


I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.

Bre

location unknown


Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous




Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous




Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.

Anna

Poland




Thanks for taking time to read and answer so many questions. It is truly a public service!

Esh

Seattle, WA


I just wanted to say that I am very greatful for this website!!

Bonnie

location unknown




Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.

Bill

New Jersey




Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

Debbie

location unknown




Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.

Chrissy

location unknown




Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!

Tracy

Evansville, IA




Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

location unknown




Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.

-Sunny.

location unknown




Thank you very much for the information, I will consider it. Excellent web site.

Jackie

San Diego, CA




Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY




Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown




THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS




thanks again, this site is very helpful.

mark

Boston, MA




Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.

Michelle

Colorado




Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.

annielou

Colorado


Wonderful advice

by: Anonymous

This is the best site for foot problem info.


Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

Canada
I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......

Bonnie

location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!

Nancie

Wisconsin
Thank you for your response. You have provided some great insight (to my question)....

Julie

location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!

Renae

North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown


Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida
Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey


Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown


I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC


Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA


I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown