from organ issues related to kidney, heart, liver; or local vascular issues frequently seen with venous insufficiency or lymphedema. If this swelling does not remit as anticipated with current medical management, I do believe it is important that further investigation occurs to determine why the swelling in your feet persists.
suggest proprioceptive dysfunction. Nerve endings around our joints that allow us to appreciate spatial relationships of our anatomy and appropriately adjust if placed in awkward positions. Structural dysfunction results from true ligament disturbance by tear or attenuation or bony deformity that drives our ankle to rotate inappropriately. There are situations that ankle instability arises from both functional and structural deficits.
Diabetics are prone to diseases of these systems resulting in poor circulation and loss of nerve function that may leave an individual susceptible for injury to include wounds as well as bone and joint trauma. It is for this reason that we recommend to our diabetics vigilant regular examination of their lower extremities and feet to include visual examination and manual palpation. Stringent glycemic control is the mainstay of care, but when complications do develop immediate attention by a specialist well-versed in the diabetic foot is critical to prevent significant sequelae. Patients with identified compromise to include neurologic and vascular of the lower extremities warrant regular examination by such a specialist and in fact hygienic care to include management of nail disorders and skin disorders is typically covered by insurance with the understanding of this risk.
many factors that may interfere with wound healing. Mechanical factors such as repetitive stress to a wound that does not allow for appropriate maturation. This can occur over areas of excessive skin mobility or joint motion. It can also occur in areas of pressure loading on the sole of the foot. Our skin is a primary barrier of infection to the body. We colonize many
microorganisms on our skin that once this barrier is breached can then result in contamination and ultimately infection. Infection can retard the normal healing process and so it is imperative that it is resolved with local antiseptic care or systemic antibiotics. Intact vascular standing is also absolutely critical for appropriate wound healing particularly to the lower extremities and feet. Impairment of blood flow can slow healing as it impacts the ability for the previously mentioned signal factors and cells to migrate to the area. Individuals who
misuse tobacco products impact small vessel flow particularly to the skin and this can be a critical factor in delayed wound healing. Nutritional deficits and metabolic disorders also play a role in wound healing. Vitamin deficiencies and disease states such as diabetes can influence timeliness of healing. As I am uncertain as to what is meant by my foot wound has not healed and what it represents currently I cannot tell you whether it is appropriately recovering at this time. In an otherwise healthy individual superficial wounds will again heal with initial clotting and hemostasis for blood control followed by overlying eschar or scab with gradual contraction and loss of this eschar with new skin growth. If there remains a persistent open wound that is draining or failing to show contraction and closure then I do believe it would be best that this be medically evaluated and assessed for some of the common reasons if otherwise healthy as an individual to include persistent infection, failure to adequately protect the area from excessive stress or strain and potentially there may be a retained foreign body if in fact there was external forcible injury from a rock.
nervous system. Emotional sweating is affected by different regions of the brain and may be a factor with regards to the development of this condition. It is for this reason that when under stress we tend to perspire more. Treatment clearly is to address factors that influence this. Things that overstimulate are sympathetic nervous system are attempted to be mitigated. Reducing stress, limiting caffeinated products can be quite helpful. First line of treatment is typically a topical antiperspirant most commonly with some type of aluminum chloride solution as a drying agent. Secondary therapy in severe cases can include use of botulinum toxin injections. These interfere with sympathetic nerve function by blocking the neurotransmitter acetylcholine. There are also oral systemic therapies to include anticholinergics, clonidine as well as beta blockers and benzodiazepines, however, there are side effects that limit primary use. Iontophoresis as a treatment based on electric current to inhibit sweating. Finally, in the most severe of cases when involving the upper extremities, endoscopic surgical thoracic sympathectomy has been performed.
medicine such as acetaminophen or ibuprofen if tolerated. Typically, this is a self-limiting process, but may require 6-9 months to fully recover. If pain becomes notably severe and does not demonstrate improvement, then an evaluation by foot and ankle specialist may be indicated.