"If only you could have gotten here earlier"

I frequently say the following phase to my patients "if only you could have gotten here earlier", mostly referring to new wounds or infections they present with. It is important to know what to look for early on.

     The one thing that can't be relied upon is pain. Considering the increasing prevalence of Diabetes and neuropathy pain may be diminished or completely absent in many cases. One must rely upon visual cues to protect themselves. Even temperature as an indicator may be misleading due faulty mechanisms in the diabetic population.

       The precursor to a wound may be an area of redness on the foot that will not blanch (turn white when pressing on it). This is called Stage 1, the start of a deep tissue injury.

        A wound may also start as a callus that begins to show bruising.  The bruising is bleeding underneath the callus that is also a sign of deep tissue injury.  Both of these above issues need immediate decreases in pressure to occur to stop the process before the next stage occurs which is an open wound.

       Other things to look for are new swelling.  An area that is red or bruised and swollen is showing more than one sign of infection.  Add in some warmth and you have three signs.

       Additionally one must keep in mind changes that occur outside the foot. Changes in blood sugar or body temperature with a sudden spike can indicate an infection starting especially when adding in the local factors occurring in the foot.

        The take home message here is to be vigilant and don't wait to call your doctor. Stopping wounds requires the patient to be the doctor’s eyes outside the office.


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