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Treating Foot Ulcers
How a Wound Care Center Can Help

by William J. Ennis, DO, MBA, and Patricio Meneses, PhD

The multidisciplinary team at a wound care center may consist of a variety of additional health-care professionals. Most wound care centers have wound nurses on staff, many of whom have credentials such as CWCN (Certified Wound Care Nurse), CWON (Certified Wound Ostomy Nurse), or CWOCN (Certified Wound, Ostomy, and Continence Nurse). These credentials are available to nurses who either complete specific coursework or accrue a certain number of hours of experience in the field of wound care.

Other members of the wound care team may include orthotists, who design and fit braces, splints, and special foot-wear; physical therapists, who can help a person return to his regular activities as the wound is treated; medical technicians, who specialize in certain diagnostic techniques or therapies (such as a Certified Hyperbaric Technologist, or CHT); diabetes educators; dietitians; and physicians from various other specialties.

Treatment at a wound care center usually begins with a comprehensive medical history and physical exam. The wound care center clinician who examines you needs to know about any past surgical procedures you have undergone, medicines you take, and medical conditions you have to arrive at an accurate diagnosis of your wound. Plan to bring this information with you on your first visit. During this visit the clinician may also perform a vascular test. This test may be as basic as feeling for pulses or may involve a Doppler examination, in which sound waves are used to generate audible signals that correlate with the blood flow through your veins and arteries. Both of your feet should be evaluated during the first visit and possibly also at subsequent visits. If the clinician who examines you does not ask to see both feet, ask that he do so. The clinician should also perform some form of sensory testing to the bottoms of your feet to check for sensory neuropathy. The inability to feel pressure from a 10-gram sensory testing nylon monofilament at any one site is equivalent to having loss of protective sensation. This finding indicates a high risk for developing a foot ulcer and may require the use of special therapeutic shoe inserts to lessen this risk. People with loss of protective sensation should be fitted with inserts for their shoes, and if their neuropathy is severe and/or significant foot deformities are present, custom-molded shoes will be required as well. Often, a person with diabetes first becomes aware of his sensory neuropathy during one of these exams.

After your initial exam, it is very common for lab testing and x-rays to be ordered. Once the wound care team has all of the relevant background information, they will be able to select a specific dressing for your wound, and you and/or your caretaker will be instructed on proper dressing techniques for home use. For most purposes, moist wound-healing treatments are used. This means that the wound is maintained in a moist environment at all times. (The traditional belief that “letting the air get to it” is the best technique for treating a wound has long been disproved; this technique actually often leads to overdrying of the wound bed, with subsequent poor healing.)

In addition to wound care therapy, a wound care clinic should provide educational resources and hands-on education. Information sheets on proper foot care, nutrition, wound treatments, and warning signs to watch for should all be available. Organizations such as the American Diabetes Association, the Wound Healing Society, and the American College of Foot and Ankle Surgeons supply printed guidelines for diabetic foot care. Inquire about these documents when you visit the wound care clinic.

After two to four weeks of appropriate wound care, you and your wound care clinicians should notice a significant improvement in the wound bed. Improvement may be evidenced by a decrease in wound size or an improvement in the quality of the wound bed tissue. For example, the elimination of yellow debris and the appearance of granulation tissue, which is red due to the presence of newly formed blood vessels, is a positive sign of healing. During this time the clinicians should also evaluate your overall blood glucose control because it is known that people with high blood glucose levels also demonstrate delayed wound healing. It is at this point in the process that a dietitian or diabetes educator may meet with you to help you develop strategies to better control your diabetes. The diabetes educator plays a vital role in a comprehensive wound care program.

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