Technically speaking, “rotten feet” is not a disease, but a clinical manifestation that can be caused by a variety of diseases: ulcers on the legs that do not heal over time.
Most of the “rotten legs” occur on the lower legs and feet and are often infected and smelly. Because of its multiple causes, most clinicians lack experience in diagnosis and treatment. Therefore, patients with “old rotten feet” are often under great psychological pressure and have no way to seek medical help, or seek medical help blindly. Some patients spend a lot of time, energy and money in many hospitals in many places, and even get cheated, but what they get in return is “rotten leg still”.
In fact, the early diagnosis of “old rotten leg” is crucial to the subsequent treatment. Different causes of “old rotten leg”, treatment ideas and ways are also very different. If the disease is confused and treated, the condition will “get worse”. It often happens that blindly seeking medical treatment leads to amputation.
What diseases can cause “old rotten feet”?
First, the lower limb deep vein valve insufficiency
This is the most common cause. Patients present with visually visible varicose veins in the lower extremities, darkened skin (hyperpigmentation) and ulcers in the middle and lower third of the lower leg. Traffic venous reflux is an important factor in ulcer formation.
Preferred diagnostic method: lower extremity venous ultrasound in the upright position to detect deep veins, traffic veins and superficial veins.
Preferred treatment option: endoscopic venous traffic branch dissection, supplemented by superficial vein surgery or deep vein valve repair.
Indications for treatment: Dilation and regurgitation of the traffic veins above the ankle are both evident and greater than 2 mm in diameter.
Common treatment errors.
1.Lying down during ultrasound examination, the real condition of the lesion cannot be reflected after the vein is emptied.
2.The ultrasound examination missed the caliber and reflux of the traffic vein and small saphenous vein, making it impossible to understand the cause of the ulcer.
3.The ultrasound examination result does not provide the specific location of the traffic branch of the lesion, which makes the doctor blind to the operation.
4.The treatment simply adopts superficial vein surgery, which is very likely to lead to ineffectiveness or recurrence of ulcer after surgery.
Second, the sequel of lower limb deep vein thrombosis
This is the second common cause, and it is easy to be ignored or misdiagnosed. The patient’s presentation is similar to that of venous valve insufficiency in that there are visible varicose veins in the lower extremities, darkening of the skin (hyperpigmentation) and ulcers in the lower middle third of the lower leg.
The characteristic signs that should not be overlooked are the presence of twisted veins in the lower abdomen and significant swelling of the lower extremities.
Preferred diagnostic methods: CT of iliac veins, ultrasound of deep veins of the lower limbs, deep venography of the lower limbs.
Preferred treatment: elastic compression therapy (compression stockings or intermittent inflatable compression therapy).
Surgical treatment: mainly includes intervention (balloon dilation ＼ stenting) and diversion surgery. Suitable for deep vein recanalization of the lower extremity in good condition
Indications for surgical treatment: only in case of occlusion or stenosis of the iliac veins. The longer the distance of the lesion, the worse the result.
Common treatment errors.
1.Overlooking the abdominal condition during physical examination.
2.Neglecting the deep vein occlusion to do superficial vein surgery hastily, which leads to the aggravation of the disease after surgery.
3.Use balloon dilation and stent implantation in the case of unsatisfactory deep vein recanalization, resulting in the failure of surgery.
Third, neuropathic diabetic foot
The patient has a history of diabetes and the ulcer is often located in the area of external pressure (shoes and ground), such as the ankle, heel and toe palmar joint. At the same time, there are often neuropathic symptoms in the foot such as numbness, burning, coldness and other sensations.
Preferred diagnostic methods: electromyography, ultrasound of arteries in the lower extremities.
Preferred treatment: blood glucose control, debridement and medication change, pressure relief.
Common treatment errors.
1. Neglecting pressure-reducing measures, resulting in poor results.
2.Inadequate antibiotic course for infected ulcers.
3. Incomplete debridement.
Lower limb arterial ischemia
It mainly includes atherosclerotic occlusive disease, thrombo-occlusive vasculitis, and ischemic diabetic foot.
Patients present with ulcers of the end, heel or toe. Characteristic clinical manifestations also include intermittent claudication, cold calf and foot skin temperature, and loss of dorsal foot pulses.
Preferred method of examination: CT of the arteries
Preferred treatment: intervention, bridging surgery.
Indication for treatment: segmental arterial occlusion.
Common diagnostic errors.
1.Omission of palpation examination of lower extremity arteries (femoral artery, N artery, dorsalis pedis artery, posterior tibial artery) when examining the body.
2.Insufficient scope of CT examination and omission of the main iliac artery, resulting in surgical failure.
3.Rashly doing surgery in the case of distal vascular occlusion (poor outflow tract), leading to surgical failure.
4.Lack of postoperative follow-up and medication guidance, leading to recurrence.
5.Neglecting smoking cessation, blood pressure control, blood glucose control and lipid control, leading to surgical failure.
V. Other reasons
Some drugs and systemic conditions can also affect the wound healing, which must be excluded and corrected during the treatment.
Prevention of “old rotten leg”
Prevention of “old rotten leg” is more effective, safe and economical than treatment of “old rotten leg”.
Prevention points]
1, varicose veins clinical in stage 4 and above (calf skin blackening), we must check the traffic vein lesions, and be endoscopic venous traffic branch dissection to deal with.
2, diabetic patients must pay attention to foot protection.
3. Patients with venous thrombosis must use early, adequate and standardized anticoagulation therapy to prevent the sequelae of thrombosis.
Patients must learn to change their own medication at home to benefit a lot.
[Remote medication change guide
Even after regular treatment, the ulcer on the leg still needs to be changed over a period of time before it gradually heals. Patients learn to change their own medication at home, which can save time and money from running to the hospital, and the quality of medication change under the remote guidance of experts will be better.