Case studies are an excellent way to demonstrate to other wound care practitioners, and to patients, what possible treatment advances and options there are. We are constantly amazed by how wounds can cause such devastation to feet and legs. Yet, with attention to wound-care principles, an open mind, and a willingness to do whatever it takes to heal a wound, even the absolute worst wounds can heal, limbs can be salvaged, and the limb can actually be functional. Look through some of our case histories and see if you agree that the human body’s ability to heal itself is truly awe-inspiring.
This is a middle-aged male who presented initially with pain, redness and large drainage ulceration to the bottom of his foot. His diabetes had been uncontrolled for some time and developed neuropathy which led to Charcot arthropathy which is the breakdown and fragmentation of the bones in the foot due to loss of sensation and nerve dysfunction from diabetes. The patient ulceration was due to the dislocation of his midfoot shown on the x-ray.
After understanding why this happened we treated him first by clearing the infection with IV antibiotics and debridement of the wound including resection of the bony prominence. Once the infection and wound improved with offloading casts he was treated with lengthening of his achilles tendon and taking a split thickness skin graft from his calve and placing it over the healthy wound base to heal this difficult wound. Lengthening his achilles decreased the pressure to the bottom of his foot and he was able to save his leg by working with his endocrinologist and following our directions as well as follow up. 3 months after his initial encounter his wound was completely healed and he was then fitted for a custom CROW (charcot restraint orthotic walker). He is now walking normally with the CROW walker and will continue to wear this until his bones completely heal.