To Your Good Health: Diabetic ulcer still hasn’t healed properly after a month

I have a diabetic non-healing ulcer on my right heel. I was told that the blood circulation in my foot isn’t very good, which is why the ulcer isn’t healing. Five years ago, I had a non-healing ulcer in my left heel. It got infected, and the infection went into my heel bone. After several months, I agreed to an amputation. But this time, I was prescribed antibiotics with bandage changes that happen every two or three days. The ulcer hasn’t healed now for over a month. Is it still possible that healing could take place?

I hope so. Most diabetic ulcers can be healed if they are treated the right way early enough. We really want to avoid amputations as they are bad for your function and cause worse outcomes later on.

One major issue is poor blood flow to the area. People with diabetes may develop poor blood flow due to large arteries being blocked, or when the small vessels aren’t working well.

If there are blockages in the large vessels, such as the femoral artery or one of its branches, then a vascular surgeon may be able to bypass the blockage.

Newer techniques of angioplasty and stents may also be used and are less invasive and risky. An angiogram is usually necessary to determine whether this approach would be useful.

If the poor blood flow is due to the small vessels, then surgical approaches aren’t as important as medication and proper wound care.

Diabetes needs to be meticulously managed with blood sugar levels kept in the normal range as much as possible; a continuous glucose monitor can help determine if your regimen is adequate.

I cannot recommend highly enough an experienced wound care nurse, who is the expert in managing nonsurgical wounds — and post-surgical wounds, too. The pressure must come off of the heel.

Non-healing diabetic foot ulcers are one of the clearest indications for hyperbaric oxygen therapy. This therapy isn’t available to everyone, but it can be very useful in addition to standard therapy.

Finally, antibiotics are guided by the results of wound cultures. These cultures need to be done by an expert to get the correct results.

I’m a 78-year-old white male who is a nonsmoker; I am 5 feet, 6 inches tall, weigh 135 pounds, and consider myself to be in excellent health. A diagnosis from a recent bone density scan showed that my FRAX 10-year probability of a major osteoporotic fracture was 11.6%, and my probability of a hip fracture was 7.3%. I exercise seven days a week and believe that my diet is excellent. My standard blood panel results are always normal in all categories. Would it be advisable for me to take Fosamax at a 70-mg dosage?

The FRAX score is the easiest way of understanding the results of a bone density scan. Even though the odds are that in 10 years, you won’t have had a fracture, your risk of a hip fracture is high enough that most experts recommend treatment to lower your risk.

Generally speaking, treatment is recommended with a FRAX score above 20% for any major osteoporotic fracture or a score that is more than 3% for a hip fracture.

Your risk for a hip fracture is significantly above the recommended threshold, even though your overall risk isn’t, which leads me to suspect that your hips are preferentially affected by osteoporosis.

If medication is recommended, a bisphosphonate such as alendronate, or Fosamax, would be the first-line treatment for men, and 70 mg weekly is a common dosage.