Diabetic foot ulcers

 

A major complication of diabetes are foot ulcers. Majority will heal as long as the blood supply to the foot is good and infection is treated appropriately. However, there are ulcers that persist for many months without healing.

 

In the traditional methods of management, they are often only treated with frequent dressing changes. Any ulcer that does not reduce in size by half within 1 month is not likely to heal with further dressing changes. Such a delay in healing can put the patient at risk of getting his or her ulcer infected. This can result in amputations.

 

If the ulcer is not infected, why does it not heal? The most frequent reason is that the blood supply is poor. Always ask your doctor to examine

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the pulses of your foot. If they are absent, one should consult a Vascular Surgeon.

 

If your foot pulses are present and the blood supply is good, but still the ulcer does not heal with long periods of dressing, you should see an Orthopaedic Foot and Ankle Specialist. The most common reason is that the diabetes has caused deformities to appear in your

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foot. One severe consequence of this is called the Charcot foot. Diabetes can also cause tendons and muscle to “tighten” causing high pressure areas in your foot that in turn cause the skin to ulcerate.

 

 

The above shows a Charcot foot with sagging of the foot and bone destruction in the middle of the foot. Ulcers can form in the bottom of the foot. The bottom xrays show the same foot after reconstruction. The alignment is now restored.


The photo

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the left shows an ulcer in the 4th toe of a diabetic patient. This ulcer has been there for 6 months. The right photo shows

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the same patient 2 weeks after a tight tendon was released. The ulcer has healed completely in 2 weeks!

This topic is courtesy of:

Dr. Chong Keen Wai

The Ortho Klinic

Gleneagles Medical Centre

Suite 08-01

6 Napier Road

Singapore ( 2588499 )

Clinic Tel: +65 64738826

Email: keenwai@gmail.com

Website: www.orthoklinic.com.sg

Chronic Ankle Pain – What could be the problem?

 

The ankle is a very complex joint. There are actually many small joints in the region of the “ankle”. One of which is the subtalar joint

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or “lower ankle joint”. Around the ankle are many tendons that runs from the leg to the

foot. These too can cause “ankle pain”.

 

A proper evaluation of ankle pain requires listening to the patient’s symptoms and then performing an examination of all the joints, tendons and ligaments. Sometimes, Xrays or MRI scan may be necessary to assist in confirming a diagnosis.

 

Treatment of ankle pain has advanced significantly. Many conditions

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which used to be less known and underdiagnosed can now be treated by minimally invasive surgery. The ankle can now be scoped (anterior and posterior ankle arthroscopy) from the front and also from the back. The tendons around the ankle can also be scoped (tenoscopic surgery). The subtalar joint can also be scoped (subtalar arthroscopy). Mini instruments have allowed us to treat many painful ankle conditions through “keyholes”. In my personal experience, the success of such surgery in improving the function of a damaged “ankle” ranges from 85 to 95%.

Ankle arthroscopy showing a “meniscoid lesion”. This is a fibrous “scar” that appears after an ankle injury that can get trapped in the joint, causing pain. Arthroscopic removal results in excellent pain relief.

Tendon scope (tenoscopic surgery) on the ankle. My published personal results

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This topic is courtesy of:

Dr. Chong Keen Wai

The Ortho Klinic

Gleneagles Medical Centre

Suite 08-01

6 Napier Road

Singapore ( 2588499 )

Clinic Tel: +65 64738826

Email: keenwai@gmail.com

Website: www.orthoklinic.com.sg

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