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WESTMED Medical Group
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Yonkers, NY  10710

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Ulcers are skin wounds that are slow to heal. In the foot, as prominent metatarsal heads on the plantar (bottom of the foot)are subjected to increased pressure, the skin begins to become callused. When subjected to shearing forces, there is a separation between the layers on this callused skin, which fills with fluid and becomes contaminated and infected. The result is a foot ulcer.

Ulcers are classified in four stages, according to how deeply they penetrate the layers of skin they have broken through.

The four stages of ulcers are:

  • Stage 1—Characterized by reddening wounds over bony areas. The redness on the skin does not go away when pressure is relieved.
  • Stage 2—Characterized by blisters, peeling, or cracked skin. There is a partial thickness skin loss involving the top two layers of the skin.
  • Stage 3—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—Characterized by breaks in the skin involving skin, muscle, tendon, and bone and are often associated with a bone infection (osteomyelitis).

The are also four major cause of foot ulcers:

  • Neuropathic—Related to the nerves and characterized by a loss of sensation in the feet.
  • Arterial—Related to poor blood circulation to the lower extremity. This type of ulcer can be very painful and is usually found on the tips of toes, lower legs, ankle, heel, and top of the foot. It can very easily become infected.
  • Venous—Related to compromised veins. These ulcers are often seen around the inside of the ankle and are slow to heal.
  • Decubitus—Derived from excessive and prolonged pressure on one area of the foot. The most common type of decubitus ulcer of the feet is bed sores on the backs of the heels of people confined to bed for long periods of time.

Foot ulcers are a common problem for diabetics. Contact casts are sometimes applied to the diabetic foot to relieve the bony prominent areas of pressure, allowing ulcers to heal.


 

Review interesting recent articles on feet.

 

From Journal Watch, June 6, 2013

The Agony of the Feet

By Amy Orciari Herman

Several new studies, including one in theJournal of Applied Physiology, have found that running barefoot or in minimalist footwear does not result in greater physiologic efficiency or injury prevention, according to the New York Times "Well" blog.

Indeed, it seems that when it comes to running, one style does not fit all. The Times quotes one expert: "I always recommend that runners run the way that is most natural and comfortable for them.... Each runner runs a certain way for a reason, likely because of the way they were physically built. Unless there is some indication that you should change things, such as repeated injury, do not mess with that plan."

New York Times "Well" blog

Journal of Applied Physiologyabstract

 

http://www.bbc.co.uk/news/health-22555774