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We have tried regular palliative care with AgNO3 when not ulcerated.
Footwear has been advised.
X-ray shows no obvious bony spurring as underlying cause.
U.S. to be done.

Would surgical intervention be a possibility?

 

There are other causes of ulceration than pressure. Consider vasospastic etiology or malignancy. I do not know what silver nitrate would do to prevent any ulcer. If it is an ulcer caused by pressure only relief of pressure will prevent recurrence. You can reduce pressure by making a change inside or outside of the foot. If shoe change and padding have not helped, only surgery to remove the pressure inducing structure will work. Dwight L. Bates, DPM, DABPS

 

I WANNA SHARE IDEA THAT ALL WOUNDS ARE NOT PRIMARY.
BEFORE DOING SOMTHING WE HAVE TO MAKE SURE WHAT ARE THEIR PRIMARY CAUSES.
UNLESS WE NOT KNOW WHAT, WE TRY MORE CONSERVATIVE FIRST.
VERY SIMPLE PROBLEM IS CONTACT ALLERGIC DERMATITIS BUT MORE SERIOUS OR COMPLICATED CAUSES ARE MALIGNANT 0R MEDICAL DISEASE SUCH AS VASCULITIS WHICH MAY BE CAUSE FROM AUTOIMMUNE DZ. OR CANCER.
SOMETIME MORE AGGRESSIVE MAKE MORE COMPLICATED.
THANKS

DR.TAWEESAK SRIKUMMOON
BKK. THAILAND E-MAIL; tia_s1@yahoo.com
IF MORE DETAIL OR PICTURE

 

Thanks for the advice - I hadn't thought of vasospasticity or malignancy which I will look into.
The AgNO3 was used to help reduce the hyperkeratotic build-up over the corn and not when it was ulcerated. This helped but as the area kept breaking down, I was unable to use it as regularly as I would have liked.

Again, many thanks.

 

I THINK OF ULCERATIVE CHRONIC ECZEMA THAT NEED TOPICAL STEROID AND UREA CREAM TWO TIMES A DAY BUT MAKING SURE THAT INFECTION CONTROLLED ALMOST SUPERFICIAL LOCALLY,MAY BE NEED TOPICAL ANTIBIOTIC OR ADD ON ORALLY FOR DAYS.
IF THICK SKIN AROUND THE WOUND WE MAKE TRIMMING AND LOCAL DEBRIDEMENT AND/OR LOCAL TISSUE BIOPSY IF INDICATED, AT LEAST CLEANSING THE WOUND.
WE FOLLOW UP 1-2 WEEKS FOR RE-EVALUATION. IF GETTING BETTER THEN TAPERING OFF OR STOP TOPICAL STEROID BUT CONTINUE UREA CREAM AND START TOP. STEROID AGAIN IF RECURRENCE.
OTHERWISE NOT IMPROVEMENT WE SURE FIND OUT FOR OTHER CAUSE.

 

Footwear, Rose Bland interdigital wedges, good debridement all necessary. Operationally I saw one woman once who has the toes spliced into each other so that there was no interdigital surface to react. It worked too.