As a vascular surgeon, foot ulcers and poorly healing wounds are a common yet challenging condition that requires my immediate attention. If untreated, or if treatment is delayed, complications such as severe infection, gangrene, or limb loss can occur. This is true even in the early stages if not treated by a specialist. Recognizing the early warning signs and knowing when to seek help is paramount in avoiding catastrophic complications that are all too common.
Over 5 million Americans are affected by non-healing or chronic wounds, which appear as foot ulcers, sores, and cracks in the skin that are slow to heal or continue to worsen. Such wounds not only represent a trying experience for the patient, but also a serious stress on medical personnel and resources.
Diabetes or vascular diseases are most commonly associated with non-healing wounds. Other conditions may exacerbate the body’s ability to heal wounds, such as advanced age, obesity, infection, immobility, poor nutrition, and a weakened immune system.
Non-healing wounds often start with an injury that goes unnoticed because of poor sensation in the feet. I’ve had many patients develop an initial injury from overzealous nail-cutting or trauma from hitting one’s foot against an object. Such wounds initially seem inconsequential, but begin to develop a paleness with increasing darkening of the affected area.
Small black dots or a redness that spreads to the top or bottom of the foot can also signify advanced infection. In more advanced stages, there may be increasing pain, redness, warmth, oozing or discharge, and a foul odor that emanates from the wound.
Diabetes may mask many of these symptoms as it can weaken one’s immune system and overall sensation.
Two main types of wounds affect the lower extremities.
Arterial ulcersare the most painful. These are often found on the heels, toes, and nail beds and exhibit a yellow, brown, grey, or black discoloration with clear punched out edges. Surrounding skin may also appear swollen and red.
These are often treated by improving the blood circulation to the leg and foot. This involves many modern techniques performed in an outpatient setting, including balloon angioplasty – the placement of a balloon within the blockage; stent placement – placement of a metal scaffold to keep the blood vessel open; directional atherectomy – “roto-rooter” and removal of plaque; or laser atherectomy – vaporizing the plaque causing blockages.
Venous stasis ulcers tend to be found on the inner part of the leg just above the ankle. These appear red and brawny in color with irregular edges, are often covered with yellowish tissue, and may exhibit drainage.
Treatment often involves ablating the underlying non-functional varicose veins through simple radiofrequency ablation (RFA) performed as a routine 15-minute in-office procedure.
Blood is vital to healing wounds and minimally invasive vascular procedures can help improve necessary blood flow. In more advanced blockages, traditional surgery creating new piping to improve blood flow may be required. A vascular surgeon has all the necessary tools needed to improve blood flow through either minimally invasive or traditional surgical techniques.
Following revascularization, wound care treatment may include a regimen of antibiotics, topical therapies, compression dressings, skin grafts, or debridement.
A novel approach to wound treatment is hyperbaric oxygen therapy. This therapy places the patient in a pressurized chamber filled with 100 percent pure oxygen, boosting the amount of oxygen delivered to bodily tissues through the vascular system.This promotes formation of new blood vessels and stimulates white blood cell growth.
To ensure your health and safety, learn to recognize the causes and symptoms of non-healing wounds. This is especially important if you are diabetic. Diabetics should partner with their care provider to monitor and maintain a healthy blood sugar level to prevent wound complications.
Bacteria growth and swelling can occur when a healthy blood sugar level isn’t maintained. This can hinder proper wound healing and possibly lead to limb loss. In fact, the CDC reports that over 60 percent of non-traumatic lower-limb amputations in the U.S. are due to diabetes complications, resulting in over 80,000 amputations annually. These numbers, while daunting, are largely preventable.
To help prevent non-healing wounds, maintain a healthy blood sugar level, manage high blood pressure and high cholesterol, and quit smoking, as this contributes to a host of serious health issues. Regularly examine your legs, ankles, and feet for wound formation and consult your physician if they do not improve within four to six weeks.
By maintaining a healthy lifestyle and through vigilance, risk for non-healing wounds can be significantly reduced and serious complications can largely be avoided. However, effective treatment through modern approaches is available should the need arise.
Don’t hesitate to contact your care provider if you think you have developed a non-healing wound. Erring on the side of caution won’t hurt and it may just prevent future complications.