An ulcer refusing to heal may be due to various diseases. Among all, diabetes, leprosy and cancer are most important. Those due to diabetes and leprosy are called Trophic Ulcers; Trophe=Nutrition. There is impaired nutrition to the place due to lack or less blood supply; neuropathy i.e. damage to the nerve fibre.
|Deutsch: Geschwür am diabetischen Fuß (Photo credit: Wikipedia)|
Lack of pain sensation, mostly in the foot, makes it vulnerable to repeated trauma; pain makes the person cautious, to use foot carefully and draws attention.
Apart from the specific disease oriented treatment, offloading of foot after debridement plays a major role in healing the ulcer.
Offloading can be achieved in various ways, among the available methods, non-removable ones are more helpful; Total Contact Cast (TCC) or plaster boot.
After through debridement of the infected and dead tissue, excision of the callous and hypertrophied skin, either TCC or plaster boot is to be applied for 21 days. After this period, the ulcer can be inspected for healing and if required, can be kept offloaded for a further period of 21 days.
Debridement of the wound helps healing by migration of platelets and thereby the growth factor; Offloading helps by saving from repetitive trauma and pressure to the part.