One common question that is asked is does a patient need a wound care nurse for an ulcer? What is the difference between what services podiatrists offer as opposed to wound care nurses?
A wound care nurse or physical therapist may work in a multi-specialty wound care center in a hospital which also includes podiatrists, vascular surgeons and prosthetists. Wound care nurses have knowledge of a wide variety of wound care products that can be utilized to help heal an ulcer. They also provide regular care of wounds, seeing patients on a weekly or more frequent basis. They may also attend to patients who are non-ambulatory, such as in a nursing home, assisted living, adult family home, or even a private home.
A podiatrist, who is a foot and ankle physician and surgeon, oversees the foot and ankle health and is interested in various factors.
1) Is there enough circulation to heal the ulcer? If not, they may need to refer the patient to a vascular surgeon, who is able to perform surgery to restore blood flow. If the patient is unable to have surgery and there is not enough blood flow, other treatments such as hyperbaric oxygen therapy may need to be considered. For venous and lymphatic ulcers where there is swelling, compression is necessary.
2) Are there biomechanical forces that may cause the wound not to heal? If there is excessive pressure in certain areas, they will prescribe devices to offload the ulcer such a total contact cast. If there is a bony prominence that causes a wound not to heal, they may perform surgery to resect the bone to help the wound to heal. If there are growths such as thick nails and calluses which cause the ulcer to form, podiatrists are able to cut down the nails or calluses to keep the pressure away and prevent recurrent formation of the wound.
3) Is there a risk of infection? Another important service a podiatrist renders is sharp debridement. This involves cutting down the callus that presses down on the wound to keep the wound from getting bigger. The inside of the wound is also cleaned up. There may be non-viable tissue such as fibrin in the wound which keeps it from healing. This has to be removed. There may also be pus pockets, abscesses and sinus tracts, which are tunnels bacteria travel down deeper into the tissue. These must be followed and opened up and cleaned out, to allow the wound to heal.
In the foot, the skin is very close to the bone. In the case especially where there is poor circulation or high blood sugar, it may be easy for the wound to progress, leading to infection or gangrene, which is tissue death. Having the podiatrist to monitor the situation is very important. Podiatrists can prescribe antibiotics if needed for infections. If the bone becomes infected and antibiotics are not working, they may need to operate to remove infected bone. In these cases podiatrists may need to admit the patient to the hospital and consult with other specialists such as infectious diseases, vascular surgery, internal medicine, to get the situation under control and save the patient’s foot and life.
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Dr. J. John Hoy is a double board certified podiatrist and foot surgeon who practices in Downtown Seattle. He has extensive experience with diabetic wound and ulcer care, having practiced in the endemic community of San Antonio, Texas, and the Swedish Cherry Hill Wound Healing Center, where he supervised Foot and Ankle Surgery Residents. His own residency saw the highest number of surgical cases in the San Francisco Bay Area.