Just the word ulcer is kind of repugnant to me. It is a harsh sounding word. In the office I try to use simple words like "opening in the skin" or "a place where the skin is open". But the sad and true fact is that an ulcer is a hole in the skin that sometimes refuses to close. Ulcers can be open for many years and can be the entry way for infections that can cost a leg, even a life. Ulcers are serious business and closing them is my business. In this monograph I am going to be honest with you and give you my opinions.

Let me start by telling you about Carol. Carol is a retired (but not retiring!) lady in my community who was referred to me by an infectious disease doctor. She has just come through a long hospitalization for an infected diabetic foot ulceration. At one point she claims she was told by her orthopedist that the quickest, and possibly best, treatment for he foot ulcer was an amputation. Instead, with scrupulous wound care and shoe and lifestyle modifications, she still has both her feet and, as I write, is free from infection and ulcerations. She has been so for the two years she has been in my practice.

WHO SHOULD TREAT AN ULCER

The simple answer is everybody. Every specialist on your team should be involved in getting your ulcer to heal. Some examples: A conscientious primary care doctor dedicated to keeping your blood sugar levels as low as is safe. A conscientious primary care doctor will also check to see if you have numbness in your feet and refer you to a podiatrist for preventive care.  If your primary care doctor is having you check your own blood sugar levels at least daily, if not three times a day, and checks your nerves with a tiny little nylon fiber on a regular basis, I would call him or her conscientious. If your blood sugar levels are still above 160-180 mg/dl despite the best care of your primary care doctor, you deserve to see a specialist; either an endocrinologist or a diabetologist. High blood sugars are diabetic ulcer time bombs. You need a podiatrist to regularly check your feet, care for your nails and calluses and make sure your shoes are not causing more problems than they help. If you have Medicare and have diabetes, you are probably eligible for a free pair of extra depth shoes every year. If your podiatrist has told you about your shoes then I call him or her conscientious. If there is not enough blood getting to your feet, you need to see either a vascular surgeon or a plastic surgeon who specializes in bypass grafts. Some vascular surgeons will settle for a leg amputation instead of a bypass graft because they say "distal grafts do not work." This is their bias but it does not help you. If you have a non-healing ulcer due to bad circulation, a distal graft will supply enough blood to the foot for the wound to heal even if the graft closes up after a year or two. If your vascular surgeon or plastic surgeon does what are called distal grafts (meaning a graft from the leg to the foot) then he or she is conscientious. If you have neuropathy that is causing pain, then you might need a neurologist. If you are not well versed in nutrition a medical nutritionist is in order. If you need help at home you can get visiting nurses or aids to help you.

WHAT IS BETTER THAN TREATING AN ULCER?

Preventing an ulcer! Nearly every foot ulcer could have been prevented. This may be the "reason d'être" of podiatric medicine and surgery. Podiatrists can do more in the way of keeping your feet in shape and modifying your shoes so that you never get an ulceration. You have to work together as well. Here are the steps you need to take to prevent an ulceration

1. EXAMINE YOUR OWN FEET

2. IF YOU ARE DIABETIC VISIT YOUR PODIATRIST - if you have poor circulation or neuropathy you should visit your podiatrist every two months. If you do not have these conditions you need to only visit twice a year.