Lisa Buenger, MD
Hyperbaric Medicine & Wound Care
OakLeaf Advanced Wound Care & Hyperbaric Medicine Center
“There is a sore on my leg that just won’t go away. I don’t remember how I got it, but it’s been there for longer than it should. Sometimes it hurts, sometimes it doesn’t. I’ve put a bandage on it but I’m not sure if I should let it air out, or protect it. A friend asked is it an infection or a tumor? I just don’t know what to do.”
Chronic wounds and ulcers frequently appear on the legs or feet of people who have difficulty healing or numbness in them.
The three most common types of leg and foot ulcers are:
- Venous stasis ulcers
- Neuropathic (often diabetic) ulcers
- Arterial insufficiency ulcers
Venous Stasis Ulcers
Venous stasis ulcers occur when the veins in the leg are not properly returning blood and fluid back to the heart. Think of a wound that is drowning. People may have leg swelling (edema), varicose veins or a history of leg clots. These ulcers are usually painful, have irregular borders and lots of drainage seeping from them. A primary goal is to help the veins return the fluid up the leg by wearing something around the leg that squeezes it, in the form of compression wraps or stockings. It can be very helpful to coordinate with a vein specialist if something more permanent can be done to reduce the swelling or vein dysfunction.
Neuropathic (Diabetic) Ulcers
Neuropathic ulcers are caused by a combination of not feeling the development of an ulcer, and by poor healing due to damaged nerves affecting the blood vessels. These ulcers can develop anywhere and are most frequent on pressure points, especially the bottom of the feet. These vulnerable areas often develop a callus, and beneath the callus an ulcer can occur and go undetected for quite some time. Symptoms of neuropathy can include tingling, numbness, burning or pain.
Arterial Insufficiency Ulcers
Arterial insufficiency ulcers make me think of ulcers that are suffocating. They just can’t get enough oxygen due to a lack of arterial blood. This is often called Peripheral Arterial Disease (PAD) or poor circulation. These ulcers are often very painful, may be associated with dark spots on the end of the toes, may look like a donut with a punched out center and are on feet that get red when dangled toward the floor and are cold and pale when held toward the ceiling. Nighttime is usually when the pain is at its worst.
When an ulcer just won’t heal, it is time to get additional medical help. A primary care provider may recommend appropriate dressings and treat infections or mild leg swelling. If that isn’t enough a specialist may be required. Ulcers may be caused by a number of other medical conditions. A Wound Care Center can help determine the cause by assessing circulation, swelling or infections and develop a treatment plan that might include podiatry, cardiology, general or plastic surgery, interventional radiology or an infectio5s disease specialist, when appropriate. Treatment is aimed at relieving pain, healing infections, improving circulation, speeding recovery and healing the ulcer.
What is OFFLOADING?
“My doctor and nurses keep saying I need to “offload” my ulcer.”
Basically, “take a load off” your ulcer would be saying the same thing. Any pressure that is placed on a non-healing ulcer or wound prevents it from healing. Walking on one’s foot puts pressure on the heel, sole, and toes. Just as a broken bone doesn’t heal as well or quickly if it isn’t protected from movement, similarly an ulcer won’t heal if pressure is placed upon it.
“What if I don’t want to change how I walk or sit?”
Then the ulcer will not recover as quickly or well, and may potentially worsen.
Dr. Lisa Buenger – OakLeaf Advanced Wound Care& Hyperbaric Medicine Center
For information or to schedule an appointment:
715-839-6869 | www.oakleafsurgical.com/wound.php
Dr. Buenger sees patients in Altoona.