Wound Clinic Case Study: Podiatric Care

CASE STUDY INTRODUCTION: PODIATRIC CARE

The following case study features the treatment of a 65-year-old female who presented to the wound clinic with a history of type 2 diabetes and hypertension, and a small ulcer on the right 5th toe, which originated as a corn. The primary physician cultured drainage from the site and referred to the wound center due to reoccurrence. Note that timeframes and dressings will not be mentioned in this case study, even though they are important, as one aides the healing process and the other determines if the healing trajectory is on target. The purpose of this case study is to provide education on evaluation and treatment without promoting specific dressings and/or products in an effort to help wound care providers concentrate on using the basic tenets of wound care.  

PATIENT’S HISTORY & FACTORS AFFECTING HEALING

• Infection:
  • soft tissue + infection
  • antibiotics started
  • osteomyelitis = negative
• Lower extremity circulation:  
  • history of vascular issues  
  • computed tomography angiography (CTA) ordered, showing right lower extremity occlusion
• Diabetes and hyperglycemia
• Inflammation
• Nutrition:  
  • body mass index = 37
  • labs within normal limits
• Trauma:  
  • ongoing friction 

WOUND ASSESSMENT & CASE PRESENTATION

Wound and periwound characteristics are important in an assessment for determining progress or wound deterioration. During this case study, these characteristics, along with objective testing, were documented, and they helped with making prompt referrals and timely interventions.

CONCLUSION

Diabetes is estimated to affect some 29 million people in the United States, according to the Centers for Disease Control and Prevention. Of those patients, 15% are expected to develop difficult-to-heal foot ulcers. There are many factors that can complicate wound healing, including neuropathy, poor circulation, uncontrolled glucose levels, soft tissue and/or bone infection, and ongoing trauma (to name a few). These ulcers can rapidly deteriorate and/or heal slowly. Vascular status is often overlooked when a wound care patient enters the clinic. Honing in on the true causative factor and the other factors that impede healing will provide each patient with the best possible outcome.

In this case study, the patient presented with diabetes and lower extremity vascular problems.  The wounded event was caused by ill-fitting shoes that created friction on the foot (and ultimately the wound). This wound presented multiple factors that needed attention before the wound would have a chance to progress through the healing phases. Due to close monitoring, it was determined that vascular status had to be urgently readdressed. While the goal was to immediately reestablish blood flow and to treat the infection, attention was also focused on glucose monitoring, wound bed preparation, utilization of advanced modalities, offloading, and patient and family education.