Diabetic Foot Ulcer Treatment Options - Orange County Southern California
Pressure accounts for 99% of why a diabetic foot ulcer occurs.
Get rid of the pressure and the ulcer will heal.
(if there is an infection present or poor circulation the healing time will be compromised)
OPTION 1
Offloading
Diabetic Shoes
Felt pads
Total Contact Casting
Offloading Walking Boots
CAM Walker
CROW Walker
Wheel Chair
Topical medication - There are so many things that can go on, this is not the main treatment factor. Keep the wound clean. You can spend thousands of dollars on topical medication, if pressure remains then the ulcer will not close.
OPTION 2
Surgery
The goal of surgery is to change the forces around the ulcer and allow faster healing.
Some patients are not able to comply with the offloading treatment (Option 1). Be honest with yourself.
Walking from the bed to the bathroom without protection on your feet negates an entire day of offloading.
Just because you have diabetes does NOT mean you can not have surgery. Surgery is very safe in diabetics. Glucose needs to be closely monitored. Poor glucose control can increase chance of post operative infection.
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An ulceration should be getting smaller every week, every month.
If the size of the ulcer has not changed then the treatment protocol needs to be re-evaluated.
I hate to see open ulcerations for a prolonged period of time because it will increase a chance of bone infection, soft tissue infection, or even becoming septic.
For more information on treatment options please contact Dr. Gennady Kolodenker, DPM, AACFAS
Specializing in Limb Preservation in Orange County.
Wednesday, December 12, 2012
Tuesday, December 11, 2012
Pediatric Foot and Ankle Surgeon Orange County
Finding the right surgeon to treat the child's foot or ankle problems can be a daunting task.
Dr. Gennady Kolodenker specializes in foot and ankle surgery, trauma for children.
Does my child need foot or ankle surgery for a fractured bone?
Children tend to heal fractures much faster than adults. Depending on the level of fracture displacement or angulation will determine the need for surgery. Some injuries can be treated with a simple cast.
I was told my child has a flatfoot. Do they need surgery?
Pes planus, or flatfoot deformity should first be treated by conservative means. Orthotics (over the counter or custom). Better shoes. Physical therapy. If feet remain symptomatic, painful, then surgery is an option.
There are various surgical options to treat the painful flatfoot deformity that has failed conservative treatment.
Surgery should not be done on the asymptomatic flatfoot. There is no proof that surgery can be done to prophylactically treat future arthritis.
My child has clubfoot, do they need surgery?
The best treatment for clubfoot is early casting. Sometimes the achilles tendon remains tight and will need to be released surgically. There are some kids that have a very rigid clubfoot and casting is not enough to correct the deformity. Surgery is a good option to release the tight ligaments and have correct foot alignment.
My child has an extra toe, what can I do?
Polydactyly or extra toe syndrome is a common malformation. The extra toe can be easily removed in the operating room. I would advise to wait for the child to be at least 6 months of age.
My child has toes that are stuck together, webbed toes. What can I do?
Syndactyly of the toes is treated by a plastic surgery technique to separate the toes. I would advise to wait till the child is at least 6 months of age. It is very difficult to do surgery on very tiny anatomy (before 6 months).
This surgery has very good success rate. Scarring in children is minimal, especially by the time they get older.
My child has an injury to the growth plate. What should I do?
There are various growth plate injuries. It is important to monitor the growth plate (via X-ray) and try to prevent early closure and angulation deformity.
Early treatment is important. Non weight bearing for a period of time might be needed. Periodic radiographs are advised. Sometimes a growth plate injury is not seen on a X-ray and an MRI might be needed for confirmation. With ankle fractures a CT scan is useful to see all the broken pieces and surgical planning.
My child broke their toe. Should I tape it?
If the toe is not displaced then the typical treatment will be to buddy tape it to the toe next to it. An X-ray is the only way to know for sure if there is displacement or fracture of the toe.
As a child I had a clubfoot, my foot is now deformed. What can I do?
Typically an untreated clubfoot will result in significant deformity and arthritis. There are surgical techniques to fix to foot and make walking more comfortable.
For a surgical consult contact Dr. Gennady Kolodenker, DPM, AACFAS. Pediatric Foot and Ankle Surgeon
Dr. Gennady Kolodenker specializes in foot and ankle surgery, trauma for children.
Does my child need foot or ankle surgery for a fractured bone?
Children tend to heal fractures much faster than adults. Depending on the level of fracture displacement or angulation will determine the need for surgery. Some injuries can be treated with a simple cast.
I was told my child has a flatfoot. Do they need surgery?
Pes planus, or flatfoot deformity should first be treated by conservative means. Orthotics (over the counter or custom). Better shoes. Physical therapy. If feet remain symptomatic, painful, then surgery is an option.
There are various surgical options to treat the painful flatfoot deformity that has failed conservative treatment.
Surgery should not be done on the asymptomatic flatfoot. There is no proof that surgery can be done to prophylactically treat future arthritis.
My child has clubfoot, do they need surgery?
The best treatment for clubfoot is early casting. Sometimes the achilles tendon remains tight and will need to be released surgically. There are some kids that have a very rigid clubfoot and casting is not enough to correct the deformity. Surgery is a good option to release the tight ligaments and have correct foot alignment.
My child has an extra toe, what can I do?
Polydactyly or extra toe syndrome is a common malformation. The extra toe can be easily removed in the operating room. I would advise to wait for the child to be at least 6 months of age.
My child has toes that are stuck together, webbed toes. What can I do?
Syndactyly of the toes is treated by a plastic surgery technique to separate the toes. I would advise to wait till the child is at least 6 months of age. It is very difficult to do surgery on very tiny anatomy (before 6 months).
This surgery has very good success rate. Scarring in children is minimal, especially by the time they get older.
My child has an injury to the growth plate. What should I do?
There are various growth plate injuries. It is important to monitor the growth plate (via X-ray) and try to prevent early closure and angulation deformity.
Early treatment is important. Non weight bearing for a period of time might be needed. Periodic radiographs are advised. Sometimes a growth plate injury is not seen on a X-ray and an MRI might be needed for confirmation. With ankle fractures a CT scan is useful to see all the broken pieces and surgical planning.
My child broke their toe. Should I tape it?
If the toe is not displaced then the typical treatment will be to buddy tape it to the toe next to it. An X-ray is the only way to know for sure if there is displacement or fracture of the toe.
As a child I had a clubfoot, my foot is now deformed. What can I do?
Typically an untreated clubfoot will result in significant deformity and arthritis. There are surgical techniques to fix to foot and make walking more comfortable.
For a surgical consult contact Dr. Gennady Kolodenker, DPM, AACFAS. Pediatric Foot and Ankle Surgeon
Monday, December 3, 2012
In Toeing - Femoral anteversion - Metatarus Adductus
A metatarsus adductus deformity is one that is isolated to the foot and has no other factors to alter the position of the foot.
For more questions on in toeing or metadductus contact Dr. Kolodenker in Orange County.
When parents present their kids with in toeing or walking funny with their feet in it is important to evaluate the entire lower extremity to rule out other causes of InToeing. Most kids are in fact very NORMAL.
The position of the foot is based on Version of bones, capsular stretch/motion, muscle balance.
Torsion: Position of the foot relative to the body line. This can be external, internal or neutral
Version: Change in the bone structure, relationship of the proximal end to the distal end (Femoral head or neck in relation to the shaft)
Degree of rotation at the hip plays a large role in a toed-in gait vs a toed-out gait.
Increased Internal rotation at the hip (more InToed Gait) is called Femoral Anteversion.
There are no studies that show any nonsurgical intervention will speed up or change the gait pattern.
No treatment is needed in most kids.
Orthotics are INEFFECTIVE for Femoral Anteversion
If deformity is severe surgery is an option. Surgery does come with its own risks.
www.OCPodiatry.com
No treatment is needed in most kids.
Orthotics are INEFFECTIVE for Femoral Anteversion
If deformity is severe surgery is an option. Surgery does come with its own risks.
www.OCPodiatry.com
For more questions on in toeing or metadductus contact Dr. Kolodenker in Orange County.
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