They can be painful and last for months without improving.
There may be some trauma to the foot, such as stubbing a toe against a table or wearing improperly fitted shoes. Usually, the wound would heal within a few weeks; however, if the arterial supply to the toes is damaged, the wound may fail to heal, or even worse, it may begin to develop a dark grey, purple or blackish discolouration (this indicates the development of gangrene or dead tissue).
To conceptualise how this happens, the foot’s soft tissue needs a certain amount of oxygen to keep the cells alive. To heal a wound, there is a much higher demand for oxygen to initiate the repair process. Whilst there may be enough blood (oxygen) to keep the already healthy skin, there may not be enough to heal the wound.
Vascular surgeons are responsible for assessing the blood supply to the foot and performing surgery to improve the blood supply when required. Their assessment involves examining the pulses in the foot, behind the knee or groin. Pulses can be challenging to feel if you are not trained in where to examine
The usual locations where they are found are over bony prominences. This is because the prominent bits of bone under the skin are more likely to rub or be injured when walking. The skin over the bone is generally fragile, and the amount of trauma to the skin is exaggerated when bone is underneath it.
Different parts of the foot derive oxygen from different vessels
When the presence of blocked arteries as a cause for an ulcer on the foot has been confirmed, the management is to restore the blood supply.
This is done by isolating which artery is blocked and how long the blockage is, using imaging to plan for intervention.
Minimally invasive (endovascular) keyhole surgery, where wires, balloons and stents open a channel for blood to flow. Depending on what artery is blocked and how severe it is, sometimes a balloon alone is adequate; other times, a stent is required to hold the artery open and prevent it from re-narrowing.
Open surgical reconstruction involves opening up an artery and removing plaque (endarterectomy) or performing a bypass (attaching either vein or fabric above and below the blocked vessel so that the blood can bypass the blocked vessel and be delivered to the foot.
Pressure should be taken off the wound until it heals, which involves wearing special shoes or boots that carry the weight off of the portion of the foot that has the wound. It is essential for diabetic patients, as they often don’t feel pain in their feet due to diabetic-related nerve damage (diabetic neuropathy)
The goal of wound care is to remove exudate from the open wound, remove ‘slough’ (the medical term for the green film that forms over open flesh, which represents the battleground between bugs in the environment and the body’s immune cells) and keep the wound bed moist enough to encourage healing, but not so moist such that the surrounding skin gets ‘macerated’ (like when you sit in a bath for too long and the pulp of your fingers turn white)
Sometimes, there is an infection associated with the ulcer. This is treated with targeted antibiotics, and swabs are taken to identify which bugs are causing the infection.
Aortic dissection is a complicated condition that requires a long conversation about its implications and cannot easily be explained through website content delivery.
An aortic dissection is a tear in the inner layer of the aorta, causing blood to flow between the layers of the aortic wall causing a life-threatening emergency.
Consulting locations
WOLLONGONG
Artery and Vein Clinic
402 Crown St
Wollongong
NSW 2500
GREGORY HILLS
Artery and Vein Clinic
Soma Centre
Suite 8/7, Gregory Hills drive
Gregory hills
NSW 2557
Orange
Artery and Vein Clinic
117 Molder st
Orange
NSW 2800
Contact Info
Wollongong
Phone: (02) 4226 9333
Fax: (02) 4229 4006
Gregory Hills
Phone: (02) 4601 1055
Fax: (02) 4601 1058
Orange
Phone: (02) 4601 1055
Fax: (02) 4601 1058
Healthlink EDI: wgvascul
Office Hours
9am – 4:30pm Monday to Friday
Phone Hours
7am – 6pm Monday to Friday
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