Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Recalcitrant superficial ulcer and contraindication to DCT

Discussion in 'Diabetic Foot & Wound Management' started by Mart, Sep 6, 2014.

  1. Mart

    Mart Well-Known Member


    Members do not see these Ads. Sign Up.
    Any comments regarding decongestion therapy in presence of this wound. Case notes for 60 YO female and wound image below.

    Thanks in anticipation.

    Cheers

    Martin

    Foot and Ankle Clinic
    1365 Grant Ave.
    Winnipeg Manitoba R3M 1Z8
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com



    Initial Presentation:

    • Left foot dorsal midfoot non-healing wound, onset May 2014, seemed to coincide with prior cryoablation of “wart”.
    • Patient mentioned having several courses of oral antibiotics over the past 2 months and believes that wound has neither worsened nor improved
    • Currently covering wound with sterile pad and Fucidin cream daily.
    • Relevant comorbidity; hypertension, cardiac disease; on pradaxa, quinapril,tiazic, metoprolol, furosemide and celebrex. Hx left tendo-calcaneus trauma which is currently not painful. Admitted to limited compliance with diuretic use when travelling. I was unable to determine if compression stocking had been tried properly in the past.
    • Routine cardio-vascular exercise regimen; non. Occupation is sedentary, mostly non-weight bearing at work
    • Mostly wearing “flip flops” because unable to fit into shoe because of swelling occasionally "New Balance" running shoes.

    I observed:

    • Pedal pulses not palpable (obscured by swelling), digital hairs were present, biphasic Doppler sounds were noted from posterior tibial artery at tarsal tunnel, digital hairs were present and no overt signs of ischaemia. This was interpreted as evidence for low probability of significant occlusive disease.
    • Pitting and non-pitting edema of foot and ankle.
    • Multiple raised papules approx. 1-2mm diameter, some of which were coalesced and predominantly at dorsal foot and anterior leg
    • Superficial “heart shaped” wound, dorsal to 4th TMT, approximately 10mm diameter with irregular shaped margins, there was irregular pigmentation of wound bed which was exudative with clear fluid, macerated at margins and no odour. There was no discomfort to palpation of wound margins. Proximal edge of margin (forming indentation of “heart shape” was raised, with what appeared to be residual lymphocystic tissue.
    • Both feet evidence of prior minor skin trauma at medial 1st toe and dorsal 3rd proximal inter-phalangeal joint. (University Of Texas Wound Classification System Grade 0-A: pre or post ulcerative non-infected non ischaemic completely epithelialised lesion)

    • Foot-wear; lateral strap of flip flop was positioned slightly anterior to wound, was extremely tight and likely causing pressure against wound whilst walking. No other foot-wear present.

    Initial impression:

    • Non-healing lymphocystic tissue which is and likely recalcitrant from multiple factors associated with phlebolymphedema
    • Predominant factors are likely excessive pressure from footwear and poorly controlled lymphedema.
    • Wound is unlikely complicated with infection currently and less likely malignancy.

    Treatment plan:

    Optimize foot-wear, patient agreed to return for a foot-wear review next week and this will be supervised. There will be difficulty unless edema can be better managed.

    I think that decongestion therapy may be helpful to mitigate the hydrostatic and inflammatory factors but unsure if contraindication to this because of wound presence may be moot if direct wound pressure can be avoided. I will seek opinion of colleagues and let you know next week.

    SC.jpg
     
Loading...

Share This Page