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Ulcers

The term ulcer, is generally used to refer to breaks in the normal integrity of the skin. Ulcers are skin wounds that are slowto heal and are classified in four stages, according to which layers of skin are broken through.

Stage 1 ulcers are characterized by a reddening over bony areas.The redness on the skin does not go away when pressureis relieved.

Stage 2ulcers are characterized by blisters, peeling or cracked skin. There is a partial thickness skin loss involving the top two layers of the skin.

Stage 3 ulcers are characterized by broken skin and sometimes bloody drainage. There is a full thickness skin loss involving subcutaneous tissue (the tissue between the skin and the muscle).

Stage 4 ulcers are characterized by breaks in the skin involving skin, muscle, tendon and bone and are often associated with a bone infection called osteomyelitis.

There are many different diagnostic tests that can be done in the course of treating an ulcer. If the ulcer appears to be infected (i.e., there is redness, and drainage) then a culture of the wound should be done. The reason for the culture is to identify the type of infection, so that you can be put on the appropriate antibiotic.

If there is suspicion of the bone being infected under the ulcer,x-rays and/or a bone scan can be done. If there is suspicion that the underlying reason for the ulceris poor circulation, then a non-invasive vascular study (doppler) can be done. This test is done to see if you have enough oxygen getting down to the area to heal the ulcer.

Ulcers occur due to different reasons, so it is very important to determine the underlying medical problem that caused the ulcer. There are essentially four main reasons people get ulcers on the foot.

Neuropathic: This type of ulcer occurs when a patient has loss of sensation in the feet. It is commonly seen in people with diabetes, but it can be caused by other reasons such as chronic alcohol abuse. These ulcers are generally seen under weight bearing areas and often will begin as a callus or a corn.

Arterial: This type of ulcer is due to poor blood flow to the lower extremities. This type of ulcer can be very painful and are usually found on the tips of toes, lower legs, ankle, heel and top of the foot. They can very easily become infected.

Venous: This type of ulcer is due to compromised veins. Veins are the vessels that take fluid out of the legs and back up to the heart. Veins have small valves that allow blood to flow only one way, back up to the heart. The valves normally block the tendency for gravity to pull the blood back down to the legs. Sometimes the valves leak or cease to work at all. If the valves do not work, then the fluid pools down in the legs, causing swelling. This swelling leads to increase pressure in the venous system,

producing discolouration of the leg and eventually this lead to ulceration. They are commonly seen around the inside of the ankle and are slow to heal.

Decubitus: This type of ulcer is caused by excessive prolonged pressure on one area of the foot. The most common place to see this type of ulcer is in a person confined to bed and they occur on the backs of the heels.

What the Chiropodist May Do

Treat the Infection

The chiropodist will thoroughly clean the wound to remove all infected tissue. Early, aggressive wound cleaning (called "debridement") has been shown to heal these wounds more rapidly. If there is an infection, antibiotics are prescribed . If the infection is serious, you may be hospitalized to receive intravenous antibiotics. Dressings are used to prevent further trauma, to minimize the risk of infection, to relieve local pain, and to optimize the environment for healing. A moist wound environment is important for wound healing to occur. You can help by keeping the area clean and moist at all times and using the

medications prescribed for you.

Reduce the Pressure

Depending on the location of your foot ulcer, you may need to keep pressure off the area. This is called "off-loading" and means avoiding all mechanical stress on the wound so that it can heal. If there is no infection, a total contact cast may be used to relieve pressure. Or your chiropodists may recommend using

"non-weight-bearing" devices such as orthopaedic shoes, a walker, crutches, or even a wheelchair or bed rest - these can help healing by relieving pressure on the injured part of your foot.

Simple daily foot care can prevent serious problems. According to the National Institute of Health, the following are simple, everyday steps that will help prevent serious complications:

1. Take Care of Your Diabetes

Make healthy life style choices to keep your blood sugar close to normal. Work with your health care team to create a diabetes plan that fits your life style characteristics.

2. Check Your Feet Every Day

You may have foot problems that you may not be aware of. Check your feet for cuts, sores, red spots, swelling, or infected toenails. Checking your feet should become part of your daily routine. If you have trouble bending over to see your feet, use a plastic mirror to help. You can also ask a family member to help you. Important Reminder - Be sure to call your doctor immediately if a cut, sore, blister, or bruise on your foot does not heal after one day.

3. Wash Your Feet Every Day

Wash your feet in warm, NOT HOT, water. Do not soak your feet because your skin will get dry. Dry your feet well. Be sure to dry between your toes. Use talcum powder to keep the skin dry between the toes and rub a thin coat of skin lotion or cream on the tops and bottoms of the feet.

4. Trim your Toenails Each Week or When Needed

Trim your toenails with clippers after you wash and dry your feet. Trim the toenails straight across and smooth them with an emery board or nail file. DO NOT cut into the comers of the nail or rip off hangnails. If you're nails are thick or yellowed, DO NOT cut your own nails, have a chiropodist trim them.

5. Wear Shoes and Socks At All Times

Wear shoes and socks at all times. Do not walk barefoot, not even indoors. It is extremely easy to step on something and hurt your feet. Always wear seamless socks, stockings, and nylons with your shoes to help avoid the possibility of blisters and sores developing. Wear shoes that fit well and protect your feet.

6. Be More Active

Walking, dancing, swimming, and bicycling are good forms of exercise that are easy on the feet. Avoid all

activities that are hard on the feet, such as running and jumping.

Created by S. & C. Hartman, Foot Works, Waterloo, Ont.

Workplace Athletes

Your ability to use your feet safely, with ease and comfort, is vital if you are to remain a valuable and productive worker. However, a large number of workers are exposed to injuries
due to prolonged periods of standing and walking. For example, a person who picks orders in a warehouse may walk up to 13 miles in a 8 hour shift. Another worker in the same
warehouse may be required to stand in one position for at least six hours during a shift. These individuals are often thought of as "workplace athletes", especially when considering that these workers perform the same tasks five to six days a week often working overtime.

There are many careers that may employ workplace athletes. Some of them include:
• Postal workers
• Bank tellers
• Parking meter attendants
• Teachers/lecturers
• Cashiers
• Factory workers
• Construction workers
• Nurses

Workplace athletes are susceptible to many of the same types of athletic injuries, caused by overuse. Lower back, hip, knee, and foot pain are frequent
complaints, in addition to an increase in callous formations and ingrown toenails.

One treatment option for overuse in a factory environment is the anti-fatigue mat, which is designed to reduce the forces encountered by the lower extremity and spine. Although
anti-fatigue mats do reduce the incidence of reported injuries, they are not successful for everyone.

Why should some individuals find relief and not others? The formula for success is unclear and while it is easy to see how forces might be reduced during walking, how such forces work in more static, standing jobs is less clear.

 

Risk Factors

What are the risks for non-traumatic lower extremity or back injury on the job?

1. Individuals who engage in long periods of standing and walking are at risk for injury. But this alone cannot explain why some individuals suffer injuries and others do not. The type of job and the flooring can re potential risk factors. For example, jobs that do not allow the individual to switch among several positions may have higher risks.

2. The type of shoes worn is also a consideration Poorly fitted shoes and work boots may aggravate callouses and ingrown toe nails. They may also accentuate a structural abnormality of the foot.

3. Obesity is another potential risk because it affects the forces exerted on the spine and lower extremity joints during both walking and standing.

4. Previous injury to a specific area that never really recovers may also be a risk for chronic workplace injury.

5. Perhaps the greatest risk is structural abnormality of the foot and lower extremity, such as a flat foot, excessive pronation or supination.

In considering risk factors, it is important to remember that a single risk factor usually does not lead to injury. A combination of risk factors is usually involved.

In the US there are about 120,000 job-related foot injuries. One third of them are toe injuries.

You can't take your feet for granted, and your concern for them cannot be divided. It should continue off the job, as well as at work.

 

Possible Treatment Plans

A Chiropodist is able to treat foot problems of the workplace athlete.

Ill fitting footwear, (such as work boots) and poor foot structure may be the cause of corns, callouses and ingrown toe nails. Regular, routine treatment by a Chiropodist can easily relieve the pain and discomfort caused be corns and callouses.

Ingrown toe nails can be also be managed with regular treatments.

Surgical removal of all or part of the toe nail may be an alternative.

More complicated problems such as heel knee or back pain require a thorough evaluation by the Chiropodist to determine the underlying factors causing the pain (see risk factors). These types of problems often require a combination of treatments which may include:

• Icing the affected area
• Strapping
• Laser therapy
• Orthotics
• Orthopaedic footwear
• Surgery

However, the best treatment plan for any foot problem is prevention.

Most foot problems can be avoided by following the these simple recommendations:
• Bathe your feet daily and dry them thoroughly.
• Check you feet frequently for corns, callouses and cracks.
• Keep your feet warm.
• Trim your toenails straight across, slightly longer than the end of the toe.
•At the first sign of a problem (pain or discomfort) see your Chiropodist. DO NOT wait until symptoms become severe.

 

Did You Know?

1. Seventy-five percent of the population will experience foot health problems during their life time.
2. The foot is an intricate structure containing 26 bones, 33 joints, 107 ligaments and 19 muscles.
3. The 52 bones in your feet make up about one quarter of all the bones in your body.
4. The average person takes 8,000 to 10,000 steps a day I which cover several miles. In a lifetime it amounts to about 115,000 miles. More than four times around the earth.
5. There are approximately 250,000 sweat glands in a pair of feet and they excrete as much as half a pint moisture a day.
6. Only a small percentage of the population is born with foot problems. It's neglect, lack of awareness and ill fitting shoes that create the problems.

Does My Ingrown Toenail Need Surgery?

Ingrown toenails are one of the more common foot problems treated by chiropodists. They can be very painful, with people limiting their activity to keep off their sore feet.

Ingrown toenails are caused by impingement of the skin along the margins of the nail by the nail plate. Some ingrown toenails are chronic, with repeated episodes of pain and infection. Pain can be present without infection, and pain.

 

Complications of an Ingrown Toenail

• Infection, if present, may spread to the foot and leg, or into the blood stream.
• Loss of the nail plate from the infection or inflammation of the nail bed.
• Chronic ingrowing nails can cause deformity of the nail plate and/or surrounding soft tissues.
• A small benign tumor called a granuloma can form along the nail margins.

*** Diabetics and those with poor circulation to the feet must NEVER attempt to treat an ingrown toenail at home. Consult with a chiropodist or physician immediately.

 

What the Chiropodist May Do

Ingrown toenail treatment may need to done on a routine basis. Your chiropodist may perform any one or combination of the following procedures.
• Elevate the end of the nail plate to prevent impingement on the soft tissues.
• Prescribe antibictics or special foot soaks.
• Drain the infection.
• Surgically correct a chronic ingrown toenail.
• Surgically remove the toenail so it will not grown back.

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David Simard

David-Simard

David Simard has been practicing chiropody for the past 20 years.  He currently practices in Sault Ste. Marie, ON and his services extend to the Greater Algoma District.

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Common Problems

Common-ProblemsFoot and ankle problems are usually acquired from improper footwear, physical stress, or small mechanical changes within the foot, arthritic foot problems, congenital foot problems, which occur at birth, and infectious foot problems.

 

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Sports Injury

Sports-InjuryAnkle sprains are the most common of all athletic injuries. Ankle sprains involving the lateral or outside part of the ankle are referred to as inversion sprains and are by far the most common type. Most inversion sprains occur during sports which involve jumping and side to side movement like basketball, volleyball and soccer.

 

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Diabetic Feet

Diabetic-FootMost of us are aware that people with diabetes require special attention for their feet, but many do not know why. As foot specialists, Chiropodists deal with a wide range of issues related to diabetes on a daily basis. Much of our focus is on patient education, as we strive to prevent common complications, such as ulcers, infections and undetected trauma.

 

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