Unfortunately, this number is set to increase due to an ageing population and the prevalence of diabetes.
Chronic wounds are wounds that do not heal within four to six weeks. Examples of chronic wounds include:
As chronic wounds can be complex, they need to be treated by a multidisciplinary team. Delayed wound healing can lead to complications such as infections and gangrene requiring amputations.
For February's "Ask the Specialist", Dr Kinjal Mehta, Senior Consultant from the Department of Orthopaedic Surgery and director of the Foot & Ankle Surgery at Changi General Hospital (CGH), a member of the SingHealth group, will answer your questions on chronic wounds.
This 'Ask the Specialist' forum has closed. Thank you for your interest and participation.
1. Posted by C**********
I have a black toenail for more than 6 weeks after a lot of walking caused by the toe frequent rubbing against a shoe. The toe is not painful, but the red/black/purple discolouration does not go away. The other discoloured toenails were already recovered to normal colour. Any advice for this black toenail? I am not a diabetic patient. Thanks.
Answered by Dr Kinjal Mehta :
Dear C**,
The black toenail is likely due to "trauma"- frequent friction against a shoe (as you pointed out). It is good that the other toes have recovered. The injury to this toe may be more severe than the other toes. If the discolouration is due to a blood clot (haematoma), It should resolve as the toenail grows out. The new nail that grows should not have discolouration.
However, if the toenail discolouration is not resolved even after two months and a new nail has not grown or continues to be discoloured, a medical consultation is recommended, as there is a possibility that it might be a fungal infection which can cause chronic toe discolouration. You may wish to seek treatment at a GP clinic.
2. Posted by T**
Dear Dr Kinjal,
I am pre-diabetic and occasionally experience blisters under my feet with mild pain and itch at times. It sometimes just subsides but does burst and heal eventually at times also. Should such blistering wounds be a concern for a person with pre-diabetes such as myself?
Answered by Dr Kinjal Mehta :
Dear T**,
Blisters can occur on the feet if there is an underlying cause such as excessive pressure or infection which would cause the skin to react with blistering. It is important to determine the cause of the blisters. Blisters can be caused by poor-fitting footwear (e.g. tight, narrow shoes) or feet deformity (e.g. misshaped toes or excessively high arched feet) which could be due to diabetes or other reasons.
Patients with diabetes may not be able to detect pressure applied on the feet by poor-fitting footwear due to desensitised nerves. This may result in blisters. Additionally, poor blood supply could hinder the healing of blisters. Having recurrent blisters also makes one prone to infection.
If the blisters are itchy, there may be an underlying infection or skin condition, or a combination of factors mentioned previously. It is advisable to consult a doctor to determine the cause of the blisters and treat the underlying cause to prevent blisters.
3. Posted by M***
Hi Dr,
My questions are regarding vein ulcer surgery. My mother is not diabetic. She has a palm-sized closed wound leg ulcer due to vein issues.
1.Must the swelling totally go down before surgery can be considered?
2.What are the side effects and recovery time of vein ablation surgery for elderly in their late 70s, both common and rare cases?
3.What if after vein ablation surgery the leg swelling and ulcer issue isn't resolved, what else can be done? What if more than one vein requires the surgery to completely resolve the issue, will that affect her physical ability?
Thank you for your advice!
Answered by Dr Kinjal Mehta :
Dear M***,
Venous ulcers are a result of backflow of blood in the veins in the legs. Veins are blood vessels that carry blood from the legs back to the heart. There is normally a unidirectional flow of blood in the veins due to the presence of valves, which act as doors. When the valves are damaged, backflow of blood happens. This backflow of blood leads to an increase in the pressure in the legs, causing prominent varicose veins, swelling, darkening and itching of the skin at the shin and ulceration. Risk factors include smoking, female gender, pregnancy, obesity and occupations that require long periods of standing.
1.Although vein ablation surgery can be performed while a patient is experiencing swelling around the leg area, it is not advisable to do so when an ulcer has not healed. In this instance, compression therapy will be the main treatment to prevent excess fluid from building until the ulcer heals. Once the ulcer has healed, vein ablation surgery can be done to close the faulty veins and prevent recurrence of ulcer.
2.Possible risks associated with vein ablation surgery include bleeding, bruising, blood clots, vein inflammation, and changes in skin colour over the affected veins. Most patients can start walking and go home on the same day. However, if the patients have underlying medical conditions or are of a certain age (above 60-years old), they will undergo observation before going home the next day.
3.If there is a recurrence of ulcers despite surgery, patients are likely to require lifelong compression to prevent ulcer recurrence. Vein ablation of multiple veins can be performed within the same surgery. Her physical mobility and walking ability should not be affected.
Note: Pls discuss with your attending doctor on the most appropriate treatment options for your condition.
4. Posted by B**
Dear Dr Kinjal,
My dad has diabetes and tries to watch his diet, but he doesn’t pay attention to his feet, preferring to wear slippers wherever he goes. He is also rather stubborn. Do you have advice on what are easy steps he can take protect his feet?
Answered by Dr Kinjal Mehta :
Dear B**,
While most of us can recover quickly from a scratch on the skin, a simple scratch on an individual with a chronic disease like diabetes can become infected and develop into something more serious. This is why we often advise patients with significant risk factors such as peripheral vascular disease, diabetes, smoking to avoid tight footwear to prevent pressure around bony areas and wear covered shoes for better protection.
I would advise your dad to wear closed shoes when he is out of the house to prevent injuries and wounds from forming, especially around their feet area. Home slippers are recommended to be worn at home. Keeping floor clean of sharp objects is a good idea. They should not walk on foot reflexology paths as well due to decreased sensation and risk of injury.
Do explain to your dad that individuals with diabetes may not feel pain after a wound is inflicted because of reduced sensation in the nerves due to diabetes. It is thus crucial for those with diabetes and their caregivers to examine the feet regularly for any wounds. They should also have their feet checked regularly by a podiatrist for any wounds, deformities, callosities or decreased sensation. Chronic wounds that do not heal over time will also require medical attention.
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