We are keeping our office open to make sure our patients with infection, injuries and pain are cared for in our clean, uncrowded office instead of having to go to an Urgent Care or ER where they run the risk of being exposed to COVID-19.

Blog Archive

Why don't we leave wounds open to air? Feb 9th, 2021

Moist is better than dry Diabetic foot wounds and ulcers heal best when kept moist. If allowed to air out, wounds will scab over. The body will then have to work twice as hard to lift up the scab and heal underneath. The scab is basically a biological bandaid, which...

Shoe Lacing Techniques to Reduce Friction Blisters Feb 3rd, 2021

We know friction causes blisters, which leads to foot ulcers in people with diabetes and neuropathy. There are a couple shoe lacing techniques I’d like to share with you to help reduce the friction in your shoes. If you have a high arch foot type, the top of your foot...

Necrotizing Soft Tissue Infection Type 1 (Graphic Content) Feb 1st, 2021

This man came into the hospital with a wound on his right foot with some swelling and redness. His x-ray did not show evidence of bone infection or gas. An MRI was ordered which showed a bit of swelling in the muscles and skin, no abscess or bone infection. He...

Massive Tendon Infection In The Leg (Graphic Content) Jan 31st, 2021

This is a prediabetic male in his mid 60s who all of a sudden he developed redness and swelling in his right ankle that quickly traveled up his leg. He does not have any wounds, nor had he gotten sick recently. He had a white count in the 20s, and...

A Very Close Call With Toe Amputation (Graphic Content) Jan 30th, 2021

This is a man with type 2 diabetes who has been dealing with an ulcer for several months, unfortunately it seeded an infection surrounding the big toe. There is pus going between the toes and underneath the sulcus of the big toe, you can sortof see the change of color...

Diabetic Foot Infections Don't Always Require Amputation (Graphic Content) Jan 29th, 2021

This is a man who has been dealing with a diabetic foot ulcer for months, got infected seeding infection into the first webspace. It was opened up immediately and luckily the infection did not appear to involve the second toe despite the x-ray findings. Second metatarsal head diabetic foot ulcer with...

What is a Chopart amputation and does it work? (Graphic Content) Jan 28th, 2021

This was a patient referred to me by a surgeon who had treated him for a gas gangrene that was so bad that it required disarticulation of all five metatarsals, also known as a Lisfranc amputation. Unfortunately, the amputation stump has completely necrosed. Revising this would make his foot very...

The Power of Wound Vac and Split Thickness Skin Grafts (Graphic Content) Jan 26th, 2021

The quickest and most effective way to eradicate infection is to amputate far away from the infection. For example, toe infections can be completely controlled with a ray amputation (removal of the toe and part of the metatarsal). However, midfoot infections are very difficult to treat with a single surgery...

Blood Flow in Diabetic Feet Jan 21st, 2021

Dry gangrene of the toes Grass grows where there is water. Without water, it will dry up. The same thing happens to our body if deprived of blood, and our toes start developing dry gangrene. However, there are lots of things that has to happen before gangrene develops. There are also warning signs...

What is contiguous spread osteomyelitis and why does it go hand in hand with diabetic foot ulcers? Jan 19th, 2021

A Zebra in a Stampede of Horses The overwhelming majority of bone infections in diabetic feet are called contiguous spread osteomyelitis, meaning the bone infection began by spread from an area close by. There exists something called hematogenous spread osteomyelitis, meaning the bone infection began by spread from the bloodstream. Let me explain. When...

Diabetic Foot Infection With Osteomyelitis (Graphic Content) Jan 17th, 2021

This is a patient of mine who have had toes amputated from infected foot ulcers before, so unfortunately he already knew that he has a bad infection in his foot. The knuckle underneath the third toe is exposed and there is pus deep within his foot, making his third toe...

Understanding Diabetic Foot Infections Jan 15th, 2021

We treat infections either surgically or with antibiotics, sometimes both. How we devise the treatment plan depends on what kind of infection we are dealing with, so let’s talk about the different kinds of infections. Cellulitis (skin infection) Cellulitis is the medical word used to describe an infection of the...

Selecting Appropriate Shoe Gear Jan 14th, 2021

General Tips for Selecting Shoe Gear Picking a new pair of shoes can feel overwhelming. With a quick glance at social media, you will find ultra rigid shoes, minimalist shoes, or even sandals which all claim to be best for marathon runners. So, what really does work best? See below...

Is there or isn't there a bone infection? Jan 11th, 2021

This is something that can happen, where you have a deep foot ulcer, and rightly so, your doctor is concerned and suspicious for a bone infection because of how deep the ulcer is. An x-ray is ordered, which is negative. Well, x-rays are not very sensitive for bone infection, so...

Surgical Treatment for Diabetic Foot Ulcers Jan 4th, 2021

Surgical Treatment for Diabetic Foot Ulcers Diabetic foot ulcers are treated by removing the ground, or removing the bone. It sounds like an amputation but it’s not. Usually, foot ulcers are located on areas of the foot where there is a joint or prominence. It can be hard to tell where the...

Offloading Diabetic Foot Ulcers Jan 1st, 2021

We get diabetic foot ulcers from pressure and shear forces. It will heal if we remove the pressure and shear forces. This is called offloading. Since foot ulcers are created by basically being squished between the ground/shoe and the bone, we can offload ulcers by removing the ground or removing the bone....

Flexor Tendon Tenotomy For Diabetic Toe Ulcers (Graphic Content) Dec 29th, 2020

Diabetic neuropathy causes toes to form into hammertoes, which is a deformity that can cause ulcers to form at the tips of the toe. When this happens, they sometimes can be treated by offloading the insole. However, these ulcers are notorious for coming back or not healing therefore requiring surgery....

How Shear or Friction Causes Diabetic Foot Ulcers Dec 27th, 2020

Notice the skin moving underneath the ball of the big toe, this is called shear. When we walk, there is always a little bit of shear with every step. Think of how we rub our hands together to create warmth. If we rub the hands enough, calluses will develop, like...

How To Avoid Foot Amputation Dec 27th, 2020

The following is a true story for many patients. Before the Amputation When he was diagnosed with diabetes a year ago, he remembers his first thought was of people he knew with diabetes who have had their foot amputated. He was afraid that he was next in line, so when...

Why Do Diabetic Feet Develop Hammertoes? Dec 26th, 2020

When a toe contracts, it usually straightens back out. Over time, either due to arthritis, diabetes, or overuse, it can stay in a clawed or hammered position causing problems. For people without nerve damage (neuropathy), it can be painful. For people with neuropathy, it can cause ulcers. Hammertoe Clawtoe There...

Charcot foot Dec 17th, 2020

What we are about to discuss is pretty rare, even for people with diabetes, but something I think you should still be aware of because it can end up in leg amputation. There is a condition that can happen to people that are active, do not experience foot pain due...