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Open Toe Ankle

Open Toe Ankle

Lower extremity ulcers of the legs, ankles and feet

An ulcer is a sore on the skin or mucous membrane often associated with the disintegration tissue and the formation pus. Ulcers can result in complete loss of epidermis The title = "Dennis" dermis>, and in more advanced cases of the subcutaneous fat. Ulcers that appear on the skin are distinguished by the swollen tissue with an area of red skin. skin ulcers are often associated with diabetes, but have many other causes such as exposure to heat or cold, irritability and problems with blood circulation.

Ulcers lower extremity amputations are an increasing problem among individuals with diabetes. Data from 1983-1990 National Hospital Discharge Survey (NHDS) indicate that 6% the list of diabetes hospitalizations in the discharge record also lists a condition of the lower extremity ulcer. In diabetes hospitalizations in the list, chronic ulcers were present in 2.7% of patients. The average length of stay for discharges of diabetes with ulcer conditions was 59% higher longer than for discharges of diabetes without ulcers. Recent data suggest that foot ulcers precede approximately 85% of non-traumatic amputation lower limb (AMI) in individuals with diabetes.

More than half of lower limb amputations in the United States occur in people with diagnosed diabetes. NHDS data also indicate that there were about 54,000 diabetics who underwent nontraumatic local education authorities in 1990. Lower extremity amputations are more common in people with diabetes than without diabetes.

Several studies have shown the beneficial effect of patient education in reducing local education authorities. A randomized trial showed that patients in personal care has been useful in preventing serious foot injuries. Several prevention programs amputation of the strike have reported before and after the intervention differences in the frequency of amputation after instituting programs a comprehensive, multidisciplinary foot care. Part of hospital care and self-care program should be the topical administration of a growth factor gel in the wound.

What are the types and symptoms of ulcers? Ulcers may or may not be painful. The patient usually has a swollen leg and may feel burning or itching. There are also may have a rash, redness, brown discoloration or dry, flaky skin. The three most common types of leg and foot ulcers are:

  1. Venous stasis ulcers
  2. Arterial (ischemic ulcers)
  3. Neurotrophic (diabetic ulcers)

Ulcers are generally defined by the appearance of the ulcer, ulcer location, and shape of the borders and the skin around the ulcer look like defined below:

1. Venous stasis ulcers

Venous ulcers are located below the knee and are primarily found in the inside of the leg, just above the ankle. The base of a venous ulcer is usually red and yellow may be covered with fibrous tissue, or there may be green or yellow discharge if the ulcer is infected. fluid drainage may be important with this type of ulcer.

The edges of an ulcer venous usually irregularly shaped and the surrounding skin is often discolored and swollen. You can even feel warm or hot. With edema (swelling) of the skin may appear shiny and tight. The skin of the leg may also have brown or purple color known as "ecstasy skin changes."

Ulcers venous stasis are common in patients with a history of leg swelling, varicose veins, long-standing, or a history of blood clots in any of the superficial or the deep veins of the legs. Ulcers may affect one or both legs.

Venous ulcers affect 500,000 to 600,000 people in the United States each year and represent 80 and 90% of all leg ulcers.

2. Arterial (ischemic)

Arterial Ulcers are usually in the feet and often occur on the heels, the tips of toes, between your fingers when the fingers are rubbing together or anywhere the bones may protrude and rub against the sheets, socks or shoes. Arterial ulcers also occur commonly in the nail bed if the toenail cuts in skin or if the patient has had recent toe nails cut aggressive or an ingrown toenail removed.

The basis of an artery or ischemic ulcer usually does not bleed. It has a yellow, brown, gray or dark gray. The borders and surrounding skin usually appear as if they had been punched out. If irritation or infection are present, may or may not be swelling and redness around the base of the ulcer. There may also be redness around the foot when the leg is hanging, which often becomes redness of a pale white / yellow color when the leg is elevated.

Arterial ulcers are usually very painful, especially at night. The patient may instinctively cling to their feet on the side of the bed to relieve pain. Patients often have prior knowledge of the poor circulation in the legs and may have a disorder accompaniment.

3. Neurotrophic (diabetic)

Neurotrophic ulcers are usually located at the points of greatest pressure at the bottom of the feet. However, neurotrophic ulcers related to trauma can occur anywhere on the foot. This type of ulcers are mainly in people with diabetes, but anyone who has a lack of sensitivity of the feet can be affected.

The base of the ulcer is variable, depending on traffic the patient and may appear pink / red or brown / black. The edges of the ulcer are punched out and the surrounding skin is typically scarred.

Neuropathy and peripheral arterial disease are often comorbid in persons with diabetes. Nerve damage (neuropathy) in the foot often results in a loss foot sensitivity and changes in sweat-producing glands. Thus, a person may not feel the development of foot calluses or cracks, increasing the risk of injury or infection. Symptoms of neuropathy include numbness, tingling and burning or pain.

What causes leg ulcers? Leg ulcers can be caused by:

  1. Poor circulation, often caused by arteriosclerosis
  2. Diabetes
  3. Venous insufficiency (one failure of the valves in leg veins causes congestion and slowing of blood flow in veins)
  4. Other disorders clotting and circulation that may or may not be related to atherosclerosis
  5. Renal (kidney)
  6. Hypertension (treated or untreated)
  7. Lymphedema (accumulation of fluid that causes swelling in the legs or feet)
  8. Inflammatory diseases such as vasculitis, lupus, scleroderma or other rheumatic diseases
  9. Other medical conditions like high cholesterol, heart disease, high blood pressure, anemia cell anemia, intestinal disorders
  10. History of snuff consumption (current or past)
  11. The pressure caused by lying in one position for too long
  12. Genetics (which may be inherited)
  13. A neoplasm (tumor or cancerous mass)
  14. Infections
  15. Certain medications

How are leg ulcers diagnosed and treated?

First, the history the patient was assessed. A wound specialist will examine the wound thoroughly and can be tested as x-rays, MRIs, CT scans and noninvasive vascular studies to help develop a treatment plan. The goals of treatment are to relieve pain, speed recovery and heal the wound. Each plan patient's treatment should be individualized based on patient health, medical condition, and the ability to care for the wound.

Treatment options for all ulcers may include:

  1. Antibiotics, if an infection
  2. Anti-platelet or anticoagulant drugs for prevent a blood clot
  3. Topical wound care therapies (including topical growth factors)
  4. Compression garments
  5. Prosthetic or orthopedic available to restore or improve function of normal lifestyle

Venous ulcers are treated a little differently with compression of the leg to reduce edema or swelling. Compression can Treatments include the use of compression stockings, multilayer compression wraps, or put a bandage or ACE bandage from the toes or foot to the area below the knee. The type of treatment prescribed compression is determined by the physician based on the characteristics of the base of the ulcer and the amount of secretion from the ulcer.

The type of dressing prescribed for ulcers is determined by the type of ulcer and the appearance at the base of the ulcer. The following types of dressings:

  1. Moist to wet dressings
  2. Hydrogel / hydrocolloid
  3. Alginate dressings
  4. Collagen dressings
  5. Debridement Agents
  6. dressings antimicrobial
  7. Composite dressings
  8. Synthetic skin substitutes
  9. Growth factor ointment

The pressure ulcer treatments vary, depending on the severity of arterial disease. Noninvasive vascular tests provide the physician with diagnostic tools to assess the potential for wound healing. Depending on the condition of the patient, the doctor may recommend testing invasive surgery, endovascular therapy or bypass to restore circulation to the affected leg. The goals for the treatment of arterial ulcers include:

  1. Provide adequate protection the surface of the skin
  2. The prevention of new ulcers
  3. Extraction of irritation in contact with existing ulcer
  4. Follow the signs and symptoms of infection that may involve soft tissue or bone.

Neurotrophic ulcers are treated treaties to avoid pressure and weight-bearing on the affected leg until the ulcer healing has started. Regular debridement (removal of infected tissue) generally requires a neurotrophic ulcer can heal. Often, special shoes or orthotic devices should be used.

Wound Care Home

As indicated in the previous section, a program of proper wound care including wound care home by the patient is fundamental to the healing process. Patients should receive care instructions for caring for their wounds at home. These instructions include:

  1. The wound clean Agreement
  2. Change the dressing as directed
  3. Taking prescribed medications as directed
  4. The application growth factors as indicated current
  5. Drink plenty of fluids
  6. Follow a healthy diet, as recommended, including many fruits and vegetables
  7. Exercising regularly, as directed by a physician
  8. The use of shoes
  9. The use of compression is adjusted, if necessary, as indicated

The treatment of all skin ulcers begins with a careful and foot care. Inspection Foot and skin by the patient is very important, especially for people with diabetes. Detection and treatment of skin sores, fever early can help prevent infection and prevent the pain worse. Here are some guidelines:

  1. Gently wash the affected area in the leg and feet daily with soap Soft and warm water. Washing helps loosen and remove dead skin and other wastes, drainage of the ulcer. Gently and thoroughly dry the skin and feet, including between the toes. Not rub the skin or the area between the fingers.
  2. Every day, examine the legs and tops and soles of the feet and the spaces between the toes. Look for any blisters, cuts, cracks, scratches or other sores. Also check for redness, increased temperature, ingrown toenails, corns and calluses. Use a mirror to see the leg or foot if necessary, or have a family member look at the area for you.
  3. Once or twice a day, apply a lanolin cream based legs and soles of the feet and the tops of your feet to prevent dry skin and cracks. Do not apply lotion between your toes or in areas where There is an open wound or cut. If the skin is very dry, apply moisturizing cream more often.
  4. The nail care regularly. Trim toenails after bathing, when they are soft. Cut toenails straight across and smooth with an emery board.
  5. No self-treat corns, calluses or other foot problems. Go to a podiatrist to treat these conditions.
  6. Do not wait to treat a mild fever or skin problem. Follow your Physcia is.
  7. Ask your doctor about using a growth factor of ointment on the open wound area.

How can ulcers be prevented? Controlling risk factors can help prevent ulcers from developing or worsening. Here are some ways to reduce their risk factors:

  1. Stop smoking
  2. Control your blood pressure
  3. Control your blood cholesterol and triglyceride levels, making changes diet and taking medications as prescribed
  4. Limit your intake of sodium (salt)
  5. Manage your diabetes and other health conditions, if
  6. Exercise – start a walking program after speaking with his Physcia
  7. Lose weight if overweight
  8. Ask your doctor about aspirin therapy to prevent blood clots

About the Author

Drs. Al-Qahtani and Maguire are Co-Founders of A & G Skin Solutions, Inc. of Irvine, California, USA www.agskinsolutions.com Both Al-Qahtani and Maguire are NIH-supported research scientists, professors at medical schools, with numerous peer-reviewed publications. Maguire was awarded the NIH’s prestigious Fogarty Fellowship for his work in studying the nervous system, and Al-Qahtani has received numerous international awards for his work in immunology and medicine. Both professors have been working on stem cells dating back to 1997. Dr. Maguire is currently President of the San Diego Neuroscience Group at the Scripps Research Institute (http://www.scripps.edu/services/sdneuro/ )

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