Small venous stasis ulcer

These ulcers are caused by blood pooling in the legs due to venous insufficiency. Treatment for venous stasis ulcers include antibiotics for infection, controlling drainage, debridement of the wounds, compression dressings or stockings and possibly grafting. These wounds can take many months to heal and can be quite frustrating. Patients with these types of wounds may benefit from laser or radiofrequency ablation of incompetent veins or sclerotherapy.  Fortunately this patient is on her way to healing.  Once the wound has healed it is important to wear compression stockings.

Infected diabetic neuropathic ulcer

This ulceration was caused by friction and pressure in an uncontrolled diabetic. Treatment included antibiotics, debridement, wound care, offloading by taking pressure off the ulcer. The patient achieved control of his blood sugar with diet and adding insulin to his oral medication. The ulcer eventually went on to heal with an Apligraf and wound care. Prevention of future ulcers is achieved with periodic visits and extra depth diabetic shoes with diabetic inserts.

Infected diabetic neuropathic ulcer

This ulceration was caused by friction and pressure in an uncontrolled diabetic. Treatment included antibiotics, debridement, wound care, offloading by taking pressure off the ulcer. The patient achieved control of his blood sugar with diet and adding insulin to his oral medication. The ulcer eventually went on to heal with an Apligraf and wound care. Prevention of future ulcers is achieved with periodic visits and extra depth diabetic shoes with diabetic inserts.

Neuropathic ulcer on the great toe

This ulcer was caused by lack of sensation to the feet from neuropathy without diabetes. Treatment for this ulcer is similar to those with diabetes, offloading, diabetic inserts, shoe modifications, wound care, debridement and antibiotics if necessary.

Non infected diabetic neuropathic ulcer

This patient has a non painful ulcer of the plantar surface of her foot. Unfortunately she has already lost her other leg.

Diabetic neuropathic ulcer that started out as a callus.

Wet gangrene

A diabetic patient with acute osteomyelitis (bone infection) of the great toe and cellulitis.  It is considered "wet" due to the active infection and black necrotic tissue.

Ischemic ulcer/gangrene fourth toe

This wound is due to loss of blood flow to the small blood vessels causing the tip to turn black. There are ischemic changes to the third toe as well. This patient has a history of tobacco abuse, high cholesterol and Raynaud's disease. Treatment includes referral to a vascular surgeon for possible revascularization, smoking cessation, amputation and antibiotics for infection. Hyperbaric oxygen can also be a treatment option.

Traumatic Wound

Traumatic wounds can lead to infection in the bone. In this photo the end of the second toe is enlarged and swollen secondary to a chronic bone infection. Treatment includes local amputation and antibiotics. The patient went on to heal very well after removal of the end of his toe.

Malignant Melanoma

This may look like a diabetic wound initially but it is an aggressive form a skin cancer that must be treated quickly.  This patient had his fourth and fifth toes amputated within a few weeks of a biopsy.

Chronic Osteomyelitis First Toe 

Here is an example of chronic osteomyelitis in the great toe.  The wound bed is red and granular but centrally the wound probes to bone.   Swelling and scaling around the nail plate also suggest chronic infection.  Treatment is amputation and antibiotics. Patient is status post 2 months amputation on the right.  The patient may develop hammertoes of the lesser toes which may be treated by cutting the tendons to the bottom of the toes. 

Post Surgical Wound

This patient had a first ray amputation for acute osteomyelitis of the first metatarsal.  The wound was left open to insure that the infection had resolved and allowed to granulate by secondary intention with a VAC dressing. The wound was then treated with Apligraft after the wound became granular.

Pre-ulcerative callus in patient with diabetes and hammertoe. 

The callus is considered pre-ulcerative due to the dried blood in the callus.  The patient a percutaneous flexor tenotomy of the second toe in the office. The picture on the right show the toe one week after the procedure. 

Total contact casting for diabetic ulcers. 

Casts are applied weekly until the wound is healed and then a final application for one week after the wound has healed.  The patient is able to walk in the cast full weight bearing. 

Non-Diabetic ulcerated callus

This patient is not a diabetic, but she is profoundly neuropathic. The first picture is her wound surrounded with blood, she is on coumadin and her INR levels were higher than normal on this day. She has been dealing with this ulcer for 4 years or more. We recently performed a percutaneous flexor tenotomy on the second toe. The toe is now completely healed. (Updated picture to follow)

Diabetic Foot Ulcer

This patient presented with a new diabetic foot ulcer. This was created from wearing new shoes. It is very important to know the proper break in for new shoes and to always check your feet when removing your shoes. This patient was put into a total contact cast to offload the area. She has healed nicely.

Cavus Deformity of the foot, diabetic

This patient has a major deformity of the foot that causes him to walk on the outside of his foot. This, along with diabetes has caused him to ulcerate due to the added pressure. He is having a skin graft done soon to help him heal, and possible reconstructive surgery to correct the deformity.