Ulcers

Ulcers are skin wounds that are slow to heal. In the foot, as prominent metatarsal heads on the plantar (bottom of the foot) are subjected to increased pressure, the skin begins to become callused. When subjected to shearing forces, there is a separation between the layers on this callused skin, which fills with fluid and becomes contaminated and infected. The result is a foot ulcer.

International NPUAP-EPUAP Ulcer Definition

An ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.

Category/Stage I: Non-blanchable erythemaIntact skin with non-blanchable redness of a localized area usually over a bony prominence.

Category/Stage II: Partial thicknessPartial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough.

Category/Stage III: Full thickness skin loss. Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss.

Category/Stage IV: Full thickness tissue loss. Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often includes undermining and tunneling.

Additional Categories/Stages for the USA

Unstageable/Unclassified: Full thickness skin or tissue loss – depth unknown
Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Until enough slough and/or eschar are removed to expose the base of the wound, the true depth cannot be determined; but it will be either a Category/Stage III or IV. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.

Suspected Deep Tissue Injury – depth unknown
Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue. Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid exposing additional layers of tissue even with optimal treatment.

The are also four major cause of foot ulcers:

  • Neuropathic—Related to the nerves and characterized by a loss of sensation in the feet.
  • Arterial—Related to poor blood circulation to the lower extremity. This type of ulcer can be very painful and is usually found on the tips of toes, lower legs, ankle, heel, and top of the foot. It can very easily become infected.
  • Venous—Related to compromised veins. These ulcers are often seen around the inside of the ankle and are slow to heal.
  • Decubitus—Derived from excessive and prolonged pressure on one area of the foot. The most common type of decubitus ulcer of the feet is bed sores on the backs of the heels of people confined to bed for long periods of time.

Foot ulcers are a common problem for diabetics. Contact casts are sometimes applied to the diabetic foot to relieve the bony prominent areas of pressure, allowing ulcers to heal.

Ulcer

 

 

 

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Services

Tenex Health TX™
  • Tenex Health TX™

    Plantar fasciitis or achilles tendonitis, an inflammation, irritation and swelling of the tendon, comes from an injury or doing the things you love or need to do—over and over again. Repetitive motions, no matter how ordinary, can cause small micro tears that occur each time you use your tendon. When the micro tears do not heal properly, tendinosis (tendon degeneration) can occur.

    Percutaneous tenotomy or percutaneous fasciotomy, using ultrasonic energy powered by the Tenex Health TX™ System, is a safe and quick procedure specially designed for those who are suffering from painful conditions associated with chronic tendon damage. The procedure treats tendinosis or fasciitis in the ankle and foot.

    Tenex Health TX is based on advanced technology developed in collaboration with the world renowned Mayo Clinic.

     

    Tenex Health TX™ benefits:

    If you have tried physical therapy, cortisone injections, medication, or just taking time to ice, stretch and rest and are still in pain, talk to us. We now have a solution that does not involve general or open surgery, may give you quick pain reduction and should have you back to enjoying the things you love in a few weeks to a few months.

    Patient benefits may include:
    ∙ Quick pain relief
    ∙ Rapid return to normal activities
    ∙ Local anesthetic used instead of general anesthesia
    ∙ No sutures, no stitches (requires only a small, adhesive bandage)
    ∙ 20­minute, minimally invasive procedure (not open surgery)
    ∙ Coverage by most insurances

  • How does Tenex Health TX™ work?

    Precisely targets your damaged tissue. Your doctor uses ultrasound imaging, just like the kind used to see babies in the womb, to visualize and identify the specific location of the damaged tendon tissue.

    Gently removes damaged tissue. Once the source of your tendon pain is identified, your doctor numbs the area with a local anesthetic, allowing you to stay awake the entire time. Many people say after the numbing process—which feels like a bee sting—they felt only a slight pressure during the procedure (if they felt anything at all). Your doctor then uses gentle ultrasonic energy designed to safely breakdown and remove the damaged tissue. The ultrasonic energy is applied with the TX MicroTip, which requires only a microincision to reach the damaged tissue. Because the incision is so small and the ultrasonic energy precisely treats only the damaged tendon tissue, the surrounding healthy tissue is left unharmed.

    Requires no stitches. When the procedure is completed, your doctor applies a small adhesive bandage; no stitches are required. Because you are awake during the procedure (no general anesthesia), many people are able to drive home after the procedure.

    Can offer nearly instant pain relief with a rapid recovery. Recovery is rapid with many people being back to normal activity within 6 weeks or less. Because the surrounding healthy tissue is not disturbed, and no stitches or general anesthesia is required, there is minimal downtime and less discomfort compared to open surgery. The speed of your recovery depends on the location of your tendinitis and your individual results may vary.

     

    What areas of the body does our practice treat with Tenex Health TX™?

    Our practice treats the ankle and foot with Tenex Health TX.

  • VIDEO: Learn more about Tenex Health TX™

    As a percutaneous tenotomy or percutaneous fasciotomy procedure, Tenex Health TX is typically covered by Medicare­approved and private health insurers. It is always recommended that patients consult the treating physician and individual health plan. For more information, visit www.tenexhealth.com.

    MKT112. Rev. C


  • LAPIPLASTY® Procedure Patient Education Video from Treace Medical Concepts on Vimeo.

Patient Portal

We are pleased to provide patients with secure, 24/7 access to their health records through the Pancholi Foot and Ankle Patient Portal. Patients can safely and easily:

  • Request prescription refills
  • Update insurance/demographic information
  • Review financial statements/make secure payments
  • View lab and test results
  • Access relevant health education materials

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