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If you are a health provider, medical student, sportsman, dancer, traveler, singer, actor, runner, weight lifter, jumper,
martial artist, gymnast, alpinist, hiker, geologist or simply a person living active life and taking care of you health
you will find many interesting things on our forum.
You don't need to open an account to read the most of the postings and download files. But let's consider what you're losing without
your free account on our web forum.
- You are a Doctor or a Medical Supplier and you represent your practice or your company.
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- You cannot mark the topics you're personally interested in to get an email message as soon as this topic gets updated!
- Lots and lots more!
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- You cannot receive a Daily Digest showing all the active topics and threads.
- You cannot mark the topics you're personally interested in to get an email message as soon as this topic gets updated!
- Lots and lots more!
- You are just a usual person and you have never visited any doctor. So what are you losing withough having a free account on this forum?
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- You cannot answer questions asked by other forum members!
- You cannot start a new topic, post your own article, you comments or answer questions asked by other forum members!
- You cannnot freely upload files to the forum since it's restricted for guests!
- You cannot automatically track the latest postings made by others!
- You cannot receive a Daily Digest showing all the active topics and threads.
- You cannot mark the topics you're personally interested in to get an email message as soon as this topic gets updated!
- Lots and lots more!
In addition - there are a few hidden sub-forums available only to the forum members and you will not be able to use them without your free membership!
But you can change all that if you create your free account! It will only take a few minutes and the advantages are obvious!
Click to create your free forum account right now!
There are several practice sub-forums on our forum and this number is growing up. If you are a patient of this practice you can use
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It's very easy to start a new Topic. All you need to do is to find an appropriate sub-forum that you think is good for your quesiton, open
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New Hot Topic in » Electronic Medical Records: - Recommend EMR System...
- General Category » Free Forum » High-Heeled Shoes
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 Rank: NewbieJoined: 2/25/2011(UTC) Posts: 1 Points: 3  Location: office Layton, Utah 84041 Was thanked: 1 time(s) in 1 post(s)
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Diabetic foot ulcers can lead to infection, osteomylitis, amputation. If you surgically correct to deformity causing the diabetic foot ulcer as soon as possible before infection can occur. You can significantly reduce the complications of infection /osteomylitis / amputation. For example if the patient has a distal toe ulceration from a hammertoe deformity, correct the hammertoe and it will heal the ulcer within 1 month. Do not let the patient get their foot wet until incision is healed usually within 3 -4 weeks . Another example ulcer sub 1st metatarsal, think of surgically removing tibial sesamoid through a medial incision with possible plantar exostecomy 1st metatarsal. Usually these ulcers heal within 4 weeks. I usually use a pluse Vac flush of 6,000 cc of saline and bactracin solution intra operative correcting these ulcerations. Please let me know if I can help with any diabetic ulcerations Thanks Dr Brian Richman
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1 user thanked Dr Brian Richman for this useful post.
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 Rank: Advanced MemberJoined: 3/17/2011(UTC) Posts: 61 Points: 195
Thanks: 54 times Was thanked: 30 time(s) in 22 post(s)
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Originally Posted by: Dr Brian Richman  Do not let the patient get their foot wet until incision is healed usually within 3-4 weeks. Dr. Richman, thanks for this article. I'm sorry I cannot recall, but I saw on this forum a very simple advice how to keep the patient foot dry. I think it was in some video presentation, but cannot find it now. I will forward you the link when I find it. Mason
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 Rank: NewbieJoined: 11/26/2011(UTC) Posts: 3 Points: 9 Location: london
Was thanked: 3 time(s) in 3 post(s)
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Diabetics are prone to foot ulcerations due to both neurologic and vascular complications. Peripheral neuropathy can cause altered or complete loss of sensation in the foot and /or leg. Similar to the feeling of a "fat lip" after a dentist's anesthetic injection, the diabetic with advanced neuropathy looses all sharp-dull discrimination. Any cuts or trauma to the foot can go completely unnoticed for days or weeks in a patient with neuropathy. It's not uncommon to have a patient with neuropathy tell you that the ulcer "just appeared" when, in fact, the ulcer has been present for quite some time. There is no known cure for neuropathy, but strict glucose control has been shown to slow the progression of the neuropathy. Charcot foot deformity occurs as a result of decreased sensation. People with "normal" feeling in their feet automatically determine when too much pressure is being placed on an area of the foot. Once identified, our bodies instinctively shift position to relieve this stress. A patient with advanced neuropathy looses this important mechanism. As a result, tissue ischemia and necrosis may occur leading to plantar ulcerations. Microfractures in the bones of the foot go unnoticed and untreated, resulting in disfigurement, chronic swelling and additional bony prominences. Microvascular disease is a significant problem for diabetics and can lead to ulcerations. It is well known that diabetes is called a small vessel disease. Most of the problems caused by narrowing of the small arteries cannot be resolved surgically. It is critical that diabetics maintain close control on their glucose level, maintain a good body weight and avoid smoking in an attempt to reduce the onset of small vessel disease. Treatment: First, you must determine the cause of this ulcer. Is it neuropathic, ischemic or a combination? Base your treatment protocol on the etiology of the ulcer. Assuming that there is adequate perfusion to heal a plantar ulcer, one should have appropriate shoe modifications made to disperse weight away from the ulcerative area. Absorb any excess discharge and maintain a moist wound environment with appropriate product selection. Keep the wound edges dry. Make sure no sinus tracking occurs. Watch for infection. Debride necrotic debris and the hyperkeratotic rim as they are niduses of for infection.
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1 user thanked Benjamine41 for this useful post.
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