The Importance of Wound Care

A common warning sign of Peripheral Artery Disease (PAD) is an ulcer or a wound that is slow to heal on the feet or legs. When sores or wounds do not get enough blood it can affect your body’s ability to heal the wound and increases the risk of infection. This is why patients with poor circulation due to PAD often need special care in order to heal a wound.

Wound Assessment

Wounds are described as either acute or chronic. A chronic wound is a wound that has failed to heal in 4-6 weeks and does not move through the normal stages of healing. When wounds fail to heal, they can result in pain, infection, and can lead to amputation. In addition, chronic wounds can lead to loss of workdays and lost income.⁵

Wounds can have many different causes and multiple influences. Therefore, when choosing the right plan of care it is important that all factors that contribute to wound healing are taken care of. In other words, do not just address the wound itself, but underlying infection, nutrition, and specific patient lifestyle factors which should be considered to optimize wound healing.

PAD & Chronic Wounds

Patients with underlying PAD are at increased risk of developing nonhealing wounds and ulcers and have a higher rate of amputation. Therefore, it is important for people that have PAD to seek out wound care. Here are some common wounds that occur in patients with Peripheral Artery Disease.

Arterial Ulcers

Arterial ulcers are caused by blockages in the arteries that are responsible for delivering oxygenated blood to the lower extremities. This leads to tissue damage and a state of ischemia, as the tissue lacks the necessary oxygen for healing. These wounds or ulcers typically have a “punched out” appearance and are well-circumscribed with pale pink, gray, or yellow appearance. The ulcers may be located between or on the tips of the toes or in the lower leg and are typically full-thickness.³

Diabetic (Neuropathic) Foot Ulcers

These foot ulcers are the result of the loss of peripheral sensation, often seen in patients with diabetes. This loss of sensation causes extended microtrauma, leading to the breakdown of overlying tissue, and the eventual formation of an ulcer.⁴ The ulcer may not be painful due to lack of sensation, and often occurs at pressure points, including the plantar aspect of the foot. These ulcers tend to be round, with calloused edges and a partial- or full-thickness, and with a pale or pink appearance.

Watch this video to learn about the link between diabetes and peripheral artery disease:

Dr. Scott Brannan talks about how diabetes contributes to peripheral artery disease and neuropathy.

Causes and Risk Factors

In addition to PAD and vascular insufficiency, common contributing causes of chronic wounds include diabetes mellitus, renal failure, trauma, foot deformity, callus formation, limited joint mobility, and smoking history.

Unique risk factors for neuropathic ulcers include primary neurological conditions, alcohol-related neuropathy, spinal abnormalities, trauma, or surgery. Treatment includes managing foot care, debriding the wound, and reducing the pressure on the affected area. Amputation may become necessary in severe cases. At-risk patients should take precautions to control their diabetes, inspect their feet daily, and ensure they have proper footwear.³

Wound Care & PAD Treatment

Patients with underlying PAD and a chronic wound can help prevent serious complications by seeking treatment in the early stages of the wound, to help identify and treat both the PAD as well as other factors which may be impacting wound healing. Exercising, eating properly, avoiding tobacco, and managing any underlying conditions — such as diabetes or high blood pressure, or cholesterol — can help prevent PAD from developing or progressing.

Treatment for arterial ulcers focuses on the restoration of adequate circulation, usually via minimally invasive, or endovascular techniques or less often with surgical revascularization. All patients with PAD and ulceration are advised to control medical factors including diabetes, hypertension, and cholesterol, optimize nutrition, and stop smoking to promote a healthy wound environment and expedite healing after revascularization. A comprehensive approach to wound healing with PAD can help prevent amputation and save lives.

Learn More about Modern Vascular’s commitment to Wound Care.

See all of our Wound Care videos

Sources:

Myers, B (2008). Wound Management: Principles and Practice. (2nd Edition). Pearson Prentice Hall. Upper Saddle River, New Jersey.
Worley, C (2004). Why won’t this wound heal? Factors affecting wound repair. Dermatology Nursing. Downloaded from the web January 18,
Cleveland Clinic. Lower Extremity (Leg and Foot) Ulcers. Cleveland Clinic. http://my.clevelandclinic.org/heart/disorders/vascular/legfootulcer.aspx. Published August 17, 2017. Accessed March 28, 2019
Salcido R. Pressure Ulcers and Wound Care. Medscape Reference. http://emedicine.medscape.com/article/319284-overview#aw2aab6b2. Updated June 11, 2018. Accessed March 28, 2019.
2011 Spear, M. (2013). Acute or chronic? What’s the difference? Plastic Surgical Nursing, 33(2); pg. 98-100. Downloaded February 10, 2013. http://www.nursingcenter.com/lnc/Static-Pages/Acute-or-Chronic-What-s-th…

Foot Ulcers & Wounds

The importance of preventing and recognizing foot wounds cannot be understated: Up to 24 percent of diabetic patients who develop a non-healing foot ulcer will require amputation; put another way, foot ulcers precede 85 percent of diabetes-related amputations.

Foot Wounds and How they Occur

How do foot wounds occur? Any number of factors can contribute to a foot ulcer: poor circulation and lack of feeling, irritation of the area exacerbated by friction or pressure, trauma to the foot, and existing deformities, to name a few. In addition, long-time diabetics often develop neuropathy – nerve damage that inhibits the ability to feel the wound, often adding days before it is even detected.

PAD and diabetes not only inhibit the ability to feel the pain of a foot wound; they can also impair the body’s ability to heal an ulcer, and elevations in blood glucose can reduce the ability to fight infection, both factors leading to further damage and, again, increasing the danger of amputation. Due to a lack of feeling, you must learn to recognize other symptoms aside from the obvious ulceration, including discharge on your socks and redness and swelling of the foot.

Foot Wounds and Peripheral Artery Disease

Among the most obvious signs of advanced Peripheral Artery Disease are foot wounds and ulcers. Perhaps it is more accurate to say that foot wounds should be among the most obvious signs of advanced PAD. However, the nature of circulatory issues and numbness that is prevalent in Type 2 diabetes sufferers and others with PAD means that many people do not know they have a foot wound until days later – days that can be long enough to let infection set in and amplify the risk of amputation.

What Can You Do About Foot Ulcers and Wounds?

Before foot wounds get bad enough where amputation is an imminent risk, there are a number of things you can do:

See your podiatrist regularly to check for neuropathy and signs of foot ulcers.
Follow your doctor’s recommendations for diet and exercise to treat your diabetes and minimize the risk of foot wounds and diabetic ulcers.
Incorporate regular self-checks into your daily routine so that unfelt wounds do not go undetected; look for cuts, bruises, cracks, blisters, and any other abnormal signs that indicate a wound.
If you do have a foot wound, see your podiatrist immediately; keep it clean and change dressings regularly to prevent infection, and follow other instructions from your doctor.
Always remember to cool down by slowly walking for 5 minutes followed by light stretching of your calf and thigh muscles.
Take our PAD Risk Assessment Quiz to evaluate your own vulnerability and educate yourself on symptoms and prevention.
Even when taking precautions, you may still develop foot wounds and ulcers. Don’t delay treatment.

Modern Vascular Wound Care

If you live in Southaven, Mississippi then you have to ability to visit Modern Vascular’s Wound Care clinic. Chronic wounds are concerning and should be taken care of. Wounds that go untreated can become infected. If an infection becomes severe it may require amputation. There is a mortality rate of 50% 5 years after an amputation. It is absolutely crucial to take care of wounds, especially if they are taking longer than usual to heal.

Tips for managing peripheral artery disease

Watch “Tips for Managing your PAD” Video