A diabetic foot ulcer is an open sore or wound that most commonly occurs on the bottom of the foot in approximately 15 percent of patients with diabetes. Diabetes is the leading cause of non-traumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation.

Anyone who has diabetes can develop a foot ulcer. People who use insulin are at a higher risk, as are patients with diabetes-related kidney, eye. and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.

Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation, and trauma (ex. wearing tight shoes). Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of feeling in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain and one may not even be aware of the problem.

The primary goal in treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the in the appropriate treatment of diabetic foot ulcer:

• Prevention of infection
• Taking the pressure off the area
• Removing dead skin and tissue
• Applying medication or dressing to the ulcer
• Managing blood glucose and other health problems

There are several important factors to keep an ulcer from becoming infected:

• Keep blood glucose levels under tight control
• Keep the ulcer clean and bandaged
• Cleanse the wound daily, using a wound dressing or bandage
• Do not walk barefoot

Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound (we have advanced wound care modalities), Healing may occur within weeks or require several months.

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrists on a regular basis. He or she can determine if you are at high risk for developing a foot ulcer.

You are at high risk if you:

• Have neuropathy
• Have poor circulation
• Have a foot deformity ( i.e. bunion, hammer toe)
• Wear inappropriate shoes
• Have uncontrolled blood sugar

Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose are important in the prevention and treatment of diabetic foot ulcer. Wearing appropriate shoes and socks will go along way in reducing risks. Your podiatrist can provide guidance in selecting the proper shoes.

Dr. George Williams Announces a New Skin Grafting Technology - Xpansion Micrografting

Dr. George Williams of Ankle and Foot Center of Tampa Bay ( 38105 13th Ave in Zephyrhills, 813-715-4747) is specially trained in Xpansion Micrografting, a new grafting technique just introduced this year. Dr. Williams was the first physician in Florida to use this innovative technique to heal difficult wounds.

A brief history of the progression of grafting technology: Split thickness skin grafts are a standard reconstructive technique frequently used in patients for burns, acute wounds following surgery or trauma and chronic wounds that fail to heal with nonsurgical management. Split thickness skin grafts are considered the gold standard.

For many wounds, limited donor skin can limit skin graft availability and coverage. Intraoperative meshed expansion of split thickness skin grafts is limited to a maximum nine times and usually no more than six times.
Minced skin technology addresses the existing limitations of skin grafting. First introduced in 1958, meshing of skin grafts was limited to expansion of 9 times.

In 2002, a technique was described where it was not necessary to orient the minced skin pieces in any specific direction. This technology has been simplified and now the intraoperative expansion of 100 times is possible with complete healing of full thickness wounds using the Xpansion Micrografting System from Wright Medical.

"I have heel pain" is a comment that podiatrists hear nearly every day. Patients complain that their heel hurts when they get out of bed in the morning, or after they've been sitting for long periods of time. Heel pain is non-discriminating; just about anyone can have it. Despite the many causes, it's a prevalent problem, but one that can have solutions. The heel bone, the largest in our foot, withstands a great deal of abuse as we cram it into our shoes day after day and subject it to our full weight with every step. With such abuse, it's no wonder that heel pain (most commonly called plantar fasciitis) is a problem for so many of us. In our pursuit of healthy bodies, we often let our heel pain go without treatment for much too long. Heel pain is generally the result of faulty biomechanics (walking/gait abnormalities), that places too much stress on the heel bone and the soft tissues that attach to it. The stress can also result from injury or a bruise incurred while walking, running, or jumping on hard surfaces. It can also be due to wearing poorly constructed footwear or from being overweight. Many people complain of heel pain after a night's sleep. As you walk, the heel pain may lessen or even disappear, but that may be only a false sense of relief. The pain usually returns after prolonged rest or extensive walking. Heel pain is commonly accompanied by a heel spur, a bony growth on the underside of the heel bone. The spur, visible by xray, appears as a protrusion that can extend forward as much as half an inch. Heel spurs are a result of strain on the muscles and ligaments of the foot, or a stretching of the long band of tissue that connects the heel and the ball of the foot. Your podiatrist can evaluate and treat this condition and recommend options that help to alleviate pain. Plantar fasciitis can usually be treated without surgery, using exercise or orthotics (custom-made or prescription shoe inserts). There are many other causes of heel pain other than plantar fasciitis. These can include arthritis, Achilles tendonitis or bone bruises. Stress fractures of the heel bone can also occur, although infrequently. When children suffer from heel pain, a visit to the podiatrist is imperative because their problems may be quite different from those of adults. Regardless of the cause, evaluation by a podiatrist is your first step to relief. To prevent heel pain, try some of these tips recommended by podiatric physicians:

• Always wear properly fitted shoes specific to your activity with shock-absorbent soles, rigid shanks and supportive heel counters.
• Replace shoes frequently and avoid excessive wear and tear.
• Warm up and stretch before and after exercise. Pace yourself when starting new exercise routines.
• If you are overweight, consider losing weight to reduce the stress on your feet and other bones and muscles in your body.
• Avoid walking barefoot on hard surfaces, both inside and out.

Do you suffer from "Flat feet"?
Recently an article ran in the New York Times, My Left Foot: The High Costs of Fallen Arches Click to Read the Article. Jennifer Prestifilippo interviewed one of our physicians, Dr. Jason Bottoms for more details.

What are "flat feet"?

A condition where the arch of the foot collapses, with the entire sole of the foot coming into complete or near-complete contact with the ground.

Why is there pain associated with "flat feet"?

Pain occurs because soft tissues (tendon and ligaments) have been stretched or torn. As the soft tissues continue to be stressed, symptoms tend to worsen. When pain in the foot, ankle, back or knees does occur, the feet should be evaluated.

What is the treatment for "flat feet"?

Anti-inflammatory medications, icing, physical therapy, supportive taping, bracing, and orthotics are common treatments for painful progressive "flat foot". (Please consult your physician before taking any medications.) In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function.

If conservative treatment doesn't work what are my options?

In less severe cases of adult "flat foot", procedures involving tendons and ligaments (i.e., soft tissue procedures) may suffice. These usually result in less recovery time and postoperative discomfort. However, if the problem is a more severe deformity and arthritis has developed in the joints, then bone work may also be appropriate. In these types of procedures, bones are realigned and fixed in position as to actually construct an arch in the foot. Often times, joints are fused in order to eliminate pain that results from movement of these joints. These procedures usually require more recovery time in order for the bones to heal in the correct position.

As you head to the beach this summer we wanted to discuss some common injuries to look out for and some simple preventative treatments that you can utilize.Wear shoes to protect your feet from puncture wounds and cuts caused by sea shells, broken glass and other sharp objects. If jellyfish tentacles stick to the foot or ankle, remove them, but protect your hands from getting stung too. Vinegar, meat tenderizer or baking soda reduces pain and swelling. Also, do not forget to apply sunscreen to the tops and bottoms of your feet. Sand, sidewalks and paved surfaces get hot in the summer sun. Wear shoes to protect your soles from getting burned, especially if you have diabetes. Walking, jogging and playing sports on soft, uneven surfaces like sand frequently leads to arch pain, heel pain, ankle sprains and other injuries. Athletic shoes provide the heel cushioning and arch support that flip-flops and sandals lack. The 20 million Americans with diabetes face serious foot safety risks at the beach. Any type of skin break on a diabetic foot has the potential to get infected and ulcerate if it is not noticed right away. Diabetics should always wear shoes to the beach, and remove them regularly to check for foreign objects like sand and shells that can cause sores, ulcers and infections.