Moist Wound Care For Diabetic Feet

DIABETIC FOOT CARE

This little story would not have been possible without the help of the fine, paitent, Doctors of the Veterans Administration Hospital and Outpaitent
Clinics , who have put up with all us old and sometimes grouchy veterans. THANK YOU V. A. for all all help and time you have so freely given to
us Veterans. I doubt you will ever know how much we truly appreciate your being there for us.

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Writing & Photography:

By

Robert P. Herbst

Technical Expert:
Linda R. Jones, RN, MN,
CWOCN, CS &
Linda Alexander
Clinical Nurse Specialist.
Wound/Ostomy Specialist.

When diagnosed diabetic in 1986, I weighed in at around 350 pounds. Today,
at 220 pounds, I have my diabetes under fairly good control. I no longer need
insulin injections at the rate of 36 units twice a day. I now take oral
medications. My wife played no small part in this loss of weight.
When I went to the Crimean, Ukraine, to visit and stay with her and her son
in 1998 I was still around 240 pounds and struggling to lose more.
I was a diet of the local Ukrainian food. It was a diet of mostly vegetables and
fish. I lost another ten pounds in the six months I was there.
Diabetes is no darn fun at all. There is an unending and irreversible loss of
circulation and nerve sensitivity called, Diabetic Neuropathy Unfortunately
there is a good bit of phantom pain that goes along with this. Naturally, all
feeling in my feet has long gone.
The feeling in my finger tips is also gone and I can no longer do computer
repair because I can’t get hold of the little screws used to hold things in place.
I'd like to pass on to you a story about what can happen to diabetic feet when
you’re not very careful:
In April of 2004, I saw my podiatrist at the VA Outpatient Clinic in
Tallahassee. I had been fitted for arch supports and on this visit, the podiatrist
tore the padding off the supports, claiming I really didn't need it. Indeed the
supports were not at fault.
At the same time she gave me some foam rubber inserts to cushion my feet.
These supports worked just fine for day one.
The next day I was to go shopping with my wife. I put the foam rubber into
my shoes over the arch supports again. Here is where things went terribly
wrong.
Without feeling in my feet, I had no idea the foam rubber had slid on the arch
support and rolled up in the area under the ball of my foot and behind the big
toe of my left foot.
As I walked with my wife, the rolled up foam rubber rubbed a monster blister
in the ball of my foot and just behind the pad of my big toe. At this time I
kind of wish I’d had the sense to take a picture of the blister instead of just
the aftermath. Hind sight is always 20/20.
By the time I figured out something was wrong, my left leg, all the way up to
my knee, was red with infection and rather swollen. It scared the Hell out of
me.
I found I had a monster blister on the bottom of my foot. I mean it was a big
darn blister running from the ball of my big toe all the way back over the ball
of my Left foot. Unfortunately, the blister had infected.
The next day the blister broke open in the bathroom and there was a goodly
amount of nasty looking gray stuff all over the bathroom floor.
Luckily I has some antibiotic left over from the trip I took overseas to visit my
future wife and I took one to kill the infection. It worked, I still have my left
leg.
As a general rule, doctors don’t like it very much when their patients “Self
Medicate”, but the situation here demanded immediate action.
Although the infection flares up from time to time and I’ve found I can treat
minor flare ups by washing my foot in the bathroom sink with “Dial Soap” or
some other anti-bacterial soap.
I have since found the soap used should be very mild or you can wash the
new growth of skin out of the wound.
Soaking the foot is not recommended as it tends to soften the skin and the
practicing diabetic becomes more susceptible to wounds by stepping on sharp
objects. Walking barefoot is never recommended under any conditions.
I naturally assumed the blister would now heal but it would take lots of time to
do it.
With any kind of injury, diabetics take forever to heal especially in the feet
where the blood flow is hindered the most.
About a month later the area between my big toe and the ball of my foot
began to crack open as the skin tried to cover the creased area.
Now the blister became ulcerated and constantly oozed a clear fluid
that stained my white socks.
Diabetics should wear white socks so things like this can be readily
seen when the sock is removed from the foot.
I fussed with it as best I could until I realized there was even more and
deeper blistering under the ball of my foot. The blister seemed to go
inward layer on layer.

Today is the 19th of July and there are some interesting problems.
I have stuffed a handkerchief down into the top of the cast to keep
the rough fiberglass from scraping the skin off the back of my
knee. This has worked nicely but I still can’t bend the knee far
enough to really reach the toe of the cast.
The foam rubber at the toe continued to peel off and the tape
began to fold back. The tape just doesn’t stick or it sticks so hard
I need to let it wear off.
Since coming home I have been mystified by the great number of
small shards of fiberglass I’ve been finding on the floor of my
flat. They were just little bits but I couldn’t figure out where they
were coming from.
Last night I realized the shards were coming from the toe area of
the cast. The fiberglass at the toe has started to delaminate. One
small shard at a time the delaminated fiberglass would fold back
and break off.
I finally found out about this when the side of the cast covering
the ball of my foot broke back to half way up onto the top of my
foot. I’m trying my best to hold what’s left of the area together
with tape but as I’ve said before the tape doesn’t want to stick
properly and I can’t reach the far side of my left foot because the
cast is too high in the back.
In the picture you can see I’ve eliminated the possibility of cutting
the cast off by sawing in the wrong direction by marking the front
of the cast with two dotted saw lines. I have followed the picture
I was given after the cast was put on. I think this should eliminate
any question of where to saw.
The question of how deep to saw has yet to be resolved.
In the picture, I took yesterday evening, you can see my failed
efforts at taping the toe. The dark material is the foam rubber I
mentioned above. You can just see the corner of the handkerchief
I stuffed down the back of the cast to keep the rough fiberglass
from cutting into the back of my leg.
There is a large dark spot back there now which is probably only
a bruise but just how does one look at the back of their knee?
July 21, 2005 For those of you interested in this thing, the cast
came off today. All the ladies on the fourth floor garhered around
to see the cast saw work. The saw did a great job and I felt
nothing.
We found the wound had infected inside the cast. I suppose if it
weren’t for a good sense of humor, I think I'd lay down right now
and cry. I haven’t been this discouraged in many years. I’m back
to where I was six months ago and I’m on antibiotics again.
It’s now September 30, 2005 and I’ve been on a brand new
treatment for about six weeks. The new stuff I’m using is called,
“IDOSORB” (CADEXOMERIODINE STERILE) Basically it’s
an iodine paste and it comes out of the tube looking enough like
peanut butter one might be tempted to spread it on bread. The
remarkable thing is, the stuff seems to be working. The wound is
no longer deep and moving closer to the bone, but seems to be
healing nicely.
Of course, I’m doing my level best not to walk on the foot and this
has helped greatly. So whether it’s the treatment of my staying off
the foot may just be six of one half dozen of the other.
Anyhow the treatment is quite simple. I wash the foot, let it dry,
then apply a small dab of the Idosorb to the wound, cover it with
sterile gauze and tape it in place.
The hardest part is not walking on it. Living alone makes things
even more difficult. I go back to Lake City on October 5, 2005
and with any luck at all, I will be pronounced healed. This does
not mean I can start competing in Marathon Walking Contests. My
cane and I will be constant companions for the rest of my life and
I will always need to be watchful of the “Pressure Point” where
the wound was.
October 28, 2005, on October 26, 2005, I was informed by my
doctor at the Lake City VA Hospital, there were no more
“medical” means available at this time to close the open ulcer on
the bottom of my foot.
There is no longer any infection in it, but Dr. Alexander tells me
the wound has now become a round hole indicating it was chronic
and would remain open to matter what medical means were
employed to close it
Today the wound (Ulcer) is about the size of the end of a pencil
eraser. It is still open and pink flesh can be seen at the bottom of
the opening. It has remained this way for several months no
without changing size.
Occasionally, there is a very painful burning sensation in the pad
of my big toe. Just how I can feel this when I have no feeling in
my feet is a reasonably good question. The pain is of short
duration thankfully but it is intense.
We are now going to try something non medical. I will be getting
a “Yellow Box”. The box will have a star painted on one side
and an on/off switch. Twice a day, I’m to turn off all computers,
radios, TVs and telephones. Then, I’m to place the injured part of
my foot on the star and turn the Yellow Box on for thirty minutes.
According to what I was told during my visit with Dr. Alexander,
the Yellow Box emits strong radio waves, in a frequency thought
to promote healing of this kind of chronic ulcer.
Tests indicate some limited successes in healing these chronic
ulcers when the Yellow Box is used as directed.
Will it work on me? I’ll know better on the 16th of November
when I go back to Lake City for another checkup.
October 30, 2005, the Yellow box arrived yesterday. I was
premature in my description. The box is indeed quite yellow, so
yellow in fact it nearly hurts your eyes. The box however is
plastic and not wooden. It is made by the Regenisis Biomedical
people. It’s called the Provant Wound Closure System and to
learn more, their web site at <www.regenesisbiomedical.com>
This is Yellow Box:

January 7, 2006. I checked the wound again last night. The
moleskin dressing was to be left in place until it fell off, well, – it
fell off. I was most gratified to note the covering of new skin over
the center of the callous. The white crusty looking stuff is the
adhesive from the moleskin. The adhesive now sticks like glue. The
moleskin itself begins to fall off after the first night unless some sort
of pressure holds it in place. The area must be completely dry or
the moleskin won’t stick at all. An alcohol prep might be a good
idea.
I still have considerable periods of burning pain in the pad of the toe
just ahead of the wound. The pain seems to correspond with a
small amount of drainage from the wound, it’s just enough to soil
the dressing and leave a spot about the size of the callous in my
sock. One time there was some small amount of blood but for the
most part it’s a clear liquid.
The dark spot is a bit of lint from my carpet. It’s hard for an old
man to bend up into a position to take a picture of the bottom of his
foot. Fortunately, it’s still attached to my leg and with the help of
my VA doctors and the Provant Wound Closure System I intend to
keep it this way. There does seem to be a very small hole in about
the center of the new skin.
January 28, 2006, about a month ago, just shortly after my last
entry, I noticed a rather unpleasant smell. At first I thought maybe
the cat had killed something and I’d failed to find it. Later I found a
large stain on the dressing on my foot. The smell was coming from
this. I removed it and carefully washed my foot. I had to flush the
old dressing because of the smell, it was that bad.
The type of dressing I was to use changed on my January 18, 2006
visit to the VA Hospital in Lake City. I’m now back on the Gauze
Sponge, Iodine paste and tape. There is little to no drainage and the
wound seems to be trying hard to heal. The problem is, living alone,
there are things I must do to survive. Shopping is the biggest
problem. I try to limit this to once a month and I holler for my son’
s help to get the stuff from the car to my kitchen up stairs.
Even so the size of the hole continues to slowly shrink. Although
the Doctor disagrees with me, getting rid of the stinky stuff seems
to have helped a great deal and I firmly believe there was something
in the back of the wound that had to come out. Thankfully, the
Provant Wound Closure System continues to work it’s magic and I
look forward to complete healing in the not too distant future.

This is where we were on October 14 2004. Not pretty but true,
all diabetics need to take note. No real infection any more, but a
large hole with a yellow ring around it.
The nurse tending the wound says this looks healthy and the skin
is healing in from the sides instead of trying to push it’s way
under a hardened scab.
In the very center is the little white hole that goes in a quarter
inch. The black spots are from the oxidized sliver in the dressing.
The little white spot in the very center of the red area goes in
about a quarter of an inch. If it gets to the bone I’ll be put on
massive amounts of antibiotics in an effort to save my foot. If the
antibiotics don’t work then a part of my foot will need to be
removed.
On October 26, 2004, I returned to the VA Wound Care
Specialist. Once again the dressing method has changed. I’m now
to use ConvaTec (gauze treated with a silver solution) to cover
the open wound with the Lyofoam, foam rubber pad over this. The
whole thing again held in place by the Hypafix tape.
Apparently there is some worry about the infection now as I’m to
start taking antibiotics called "Wound Care Specialist" and I’m to
take “TERBINAFINE” to control the cracking between and under
my toes. More tissue was removed from around the opening of the
wound. My fifth operation on this thing.
Naturally, with no feeling in my feet it was easy and I felt nothing.
Toward the end of the operation I did offer to scream like I was
in great pain so the authorities would know this lovely lady was
in there with me doing her job.
I simply can’t understand why the lady declined my offer.
The answer to the Coban situation is to cover the dressing with an
old ladies stocking cut off to fit over the foot. The Coban won’t
stick to this.
On November 8, 2004, I returned to the Lake City V. A. Hospital
to let the, "Wound Care Specialist", take another look at my
problem.
The following discussion wasn’t very encouraging. Although the
hole in the bottom of my foot seemed to be getting smaller, it still
oozed copious quantities of some sort of fluid. What ever it was I
was draining from it, the stuff saturated through the ConvaTec and
the 1/4 inch Lyofoampad I’d placed over the hole.
Without any "Acticoat" left, my friend the "Wound Care
Specialist" discontinued my using the “Acticoat” and told me to
make the ConvaTec two layers thick. Seemed simple enough even
for this old man.
It took several days of showering to wash away the oxidized
silver but once clean the hole in my foot seemed to be getting
smaller.
However, whatever the stuff is draining from my foot, still
managed to saturate through the dressing and stain my socks over
a 24 hour period. It was no longer a large nasty looking bulls eye
as it had been, but it was still there.
November 14, 2004, I tried something new. Just before I went to
bed I pulled the dressing off and noted the hole was indeed a
good bit smaller but still draining through an experimental four
layers of ConvaTec.
Then in the morning I just had to play around with the thing. I put
a clean paper towel over the hole and walked on it for about
fifteen or twenty minutes.
The drainage was very evident on the towel and appeared to be
clear with a very slight pink tint, with only a very slight odor.
With the quantity drained during the twenty minute or so test, it
was no wonder the liquid saturated through the entire dressing to
my sock. It does seem we are making progress.
The rash like stuff running from the top of my Left foot half way
up my leg seems to be governed by my blood sugar. Should I fall
off the wagon and the sugar gets a bit high, the rash rages up my
leg almost to my knee.
Getting back on "the wagon causes" it to recede back down the
leg. As a general rule my blood sugar ranges from 90 to 130.
Anything over the 130 seems to encourage the rash to spread, —
rapidly. After being diabetic for some 20 years now, it still
amazes me, how little encouragement an infection needs to go
completely wild in a diabetic.
I think I’ll continue to use the ConvaTec four layers thick as the
saturation seems to take longer and only a small amount gets
through to the sock.
I’m not worried about the sock, I have a washing machine to
handle this part of the problem. There does seem to be some
concern about the ability of the liquid to get through the dressing
to the sock.
November 22, 2004. Things seem to be looking better on the
bottom of my foot but alas the drainage has as yet not stopped.
Once having removed the dressing I took a shower paying close
attention to the bottom of my foot. I was concerned the callous
was healing over and would close leaving nowhere for the
discharge to go but into a pocket under the callous.

After it dried the skin was hard and flaked off in small shards.
The skin under all this was pink but not bloody by any means. The
area where the skin flaked off is fairly easy to see in this picture.
November 23, 2004. Once again the hole had nearly closed over
and I am still concerned if the hole closed, it would form a pocket
under the callous which would continue to fill with whatever it is
now coming out of the opening.
December 1, 2004, I’m once again on antibiotics. This time I’m
taking one a day of GATIFLOXACUN 400NG TAB. The wound
itself had to be operated on again and when measured, the
infected area had grown .01MM in size, not bad, but it needs to
all go away.
I learned an interesting lesson today: ConvaTec makes two very
different AQUACEL products One is marked, AQUACEL CE and
the other is marked, AQUACEL Ag. AG indicates the material
has silver in it. I have no idea yet what the CE stands for but I
have been advised to use only the AQUACEL Ag as the silver has
some kind of infection regardant in it.
My favorite VA Wound Care Specialist was favorably impressed
with the progress we are making in getting this thing to clear up.
However I must still take care not to put weight on the ball of my
foot any more than is absolutely necessary.
I’m told to stay away from the Hypafix Tape because it seems to
trap moisture next to the skin. The skin then weakens and this is
why the large piece of skin flaked off earlier on. I need to start
using the CoBan again.
I had a terrible experience with my special shoe. This is the shoe
that puts my weight on my heel instead of the ball of my foot when
I walk. It is made of a solid hard rubberlike material. DO NOT
try to wear one of these things if the floor is wet.
I found out the hard way, the shoe loses traction on wet surfaces.
I can’t win, no sooner do I get one injury more or less under
control, when something else jumps up and bites me.

As you can see, Yellow Box is quite Yellow. The pad alongside
of it is where you put your foot or whatever it is you're trying to
heal adjacent or on top of the pad getting the star as close to the
wound as possible.
Once your injury is next to yellow box, reach into the the box in
the area the wires came out of and fint the swithc in the top right
hand corner and turn it on.
Now you have 30 minutes to do as you like, provided you don't
move. Rumors Yellow Box with muddle your TV, Radio or
Telephone are exadurated. My TV is across the room and I get no
interfearence whatsoever.
The pink bags on top of Yellow Box are the bags the wires came
in and the ties are at the bottom of the switch area.
I have now completed the second treatment and I suppose I should
be able to feel something but without feeling in my feet I’ll have
to rely on Visual assessments. Just to set your minds at ease there
was no radical sucking noise on my foot indicating the wound had
snapped shut. This is going to take time, after all I didn’t build
this problem in one night so I have to assume it will take several
days for the closure to occur.
Now that Yellow Box is here and I can safely tell you after one
full day of use, I feel absolutely no different than I did yesterday
when I got the thing. If the thing works it will be a God Send to
chronic sufferers.

Kitty may not have anything good to say about Yellow Box. I have
a nice long haired cat and you just know I had to try.
Clutching kitty gently but firmly by the tail and neck, I placed kitty
on the rubber pad and turned Yellow Box on. To say the very
least, kitty was not at all amused.
Kitty instantly inflated to nearly twice it's normal size, as every
hair on it’s body stood straight up, there was a blood curdling
screech and kitty vanished under the sofa leaving a trail of
electric sparks and hair in it's wake.
I have hopes I won't bleed to death from the scratches and bites.
It was a terrible thing to do to poor old kitty, but it sure looked
funny with every hair standing on end. Now that we've had our
little joke, back to the more serious stuff.
It may be just my imagination but there does seem to be a warm
feeling in the area of the ulcer. Tune in to this same station later in
the week for an update.
November 3, 2005, If anyone had told me Radio Waves would
cure something which has frustrated the best efforts of both myself
and the Veterans Administration Doctors since April of 2004, I’d
have laughed at them, as in fact I have done above.
Well folks I’ve been shown the light. Within a day or so of
starting to use the Provant System, the rash on the top of my left
foot has been reduced to just two bad spots and a few little areas
which are rapidly going away.
Today the callous on the ball of my foot had once again raised but
there is no crater indicating the presents of the hole in the center
of the callous. It seems to have filled in. This may be wishful
thinking as there is still some discharge from the wound but it
seems smaller in area than it was before.
I will no longer laugh at radio waves. Whatever this system does,
it seems to be working.
November 23, 2005, on November 3, 2005 the doctor measured
the hole in the ball of my foot. It measured .4mm. today it
measured .1mm. This is more healing in a shorter period of time
than the doctor had seen in quite a while.
The only thing different was the use of the Provant System.
Strange as it may seem, the yellow box works. I go back to the
doctor on December 7 and the doctor expects to see it completely
healed over.
This will not end the problem. From here on out, for the rest of
my life, I will have a “Pressure Point” and it will need monthly
attention. At least they are not still talking about cutting my foot
off.
December 2, 2005, today for the first time since April of 2004, I
pulled the dressing off my foot and there was no drainage from
the wound on the ball of my foot. Two days ago I became alarmed
at the redness of my left foot and began taking the
GATIFLOXACIN again. I’ve taken the pills last night and the
night before that. Two pills.
The redness was gone immediately and today the hole in my foot
seems to have healed over. It appears the Provant system and the
antibiotic finished the thing off. The top of my foot is still rough
so I’ll take the pills for another day or two and see what happens.
December 7, 2005, today, Dr. Alexander pronounced my foot
healed. Now we start trying to get the callous to grow back over
it. I will still be using the Provant Regenisis System for another
thirty days. As there doesn’t seem to be any infection, I’ll keep
taking the GATIFLOXACIN until Friday (another day) then I’ll
discontinue this part of the treatment.
December 12, 2005 I’m still taking the GATIFLOXACIN. The
infection on the top of my foot is still red and inflamed looking.
The new dressing is something called, “Mole Skin” and is
plastered over the troublesome area with instructions to leave it
in place until it falls off.
The problem I’m having is to get it to stick. If there is any
moisture present the stuff simply falls off. The area must be dry.
Unfortunately, my feet sweat.
I have found, if I can get it to stick for 24 hours, the mole skin
sticks like it was welded in place. The way I did this was to use
the new tape to put over the mole skin and holding it in place.
Tonight I pulled the tape off and the mole skin did not come off. I
took a shower, the mole skin remained affixed. Now my concern
turns to trying to remove it. I was told to leave it in place until it
falls off on it’s own. We shall see.
December 15, 2005, on waking this morning I found the mole skin
dressing had been saturated with a blood spot about the size of a
quarter. It was kind of scary.
I checked the white socks I’d worn yesterday and there was no
evidence of blood, so it had to have started during the night as I
slept. I have a call in to Dr. Alexander to find out if this is a good
sign or a bad sign.
This is the first time since April 6, 2004 I’ve seen blood, except
for the times when the callous was surgically trimmed by the
Wound Care Specialists who worked on this thing with me.
I couldn’t stand it any more, I just pulled the old dressing off and
found the wound had nearly healed. The callous seemed to be of
the proper color and only a little of the adhesive still stuck to the
top of the blister.
The blood must have come from a blister under the wound. This
darn thing is like a pile of blisters with one sitting on top of the
next. Most of the time they fill with a clear liquid, this time it just
happened to be blood.
A learned secret:
To get the mole skin to stay on your foot, wash the area carefully,
making sure there is no sweat or grease on the area. Dry the area
carefully and allow it to air dry a few minutes. Only then do you
apply the mole skin. Next put on a sock to keep material from
moving over the area. The worst are bed sheets when you sleep.
If the edge turns up, you’ll probably find the mole skin attached to
your sheets rather than your feet.
After twenty four hours the stuff is firmly attached and I've found
it’s quite waterproof, but don’t push your luck.
December 19, 2005. After fooling around with the mole skin
dressing I have determined there is no way to get it to stick to
ones foot if the person lives alone.
I live alone and hard as I try to stay off my feet, eventually I must
at least go to the bathroom. This causes one corner of the mole
skin to come up. From there on out the corner sticks to the bed
sheets and by morning the cat has it off in another room.
In examining this thing, as best as I can see and figure out, it’s a
pile of blisters. A blister forms and swells. Then as I’m leaving
the bed, at some point I need to put my foot on the floor. This
causes the top blister to rupture. A second blister immediately
forms under the first blister and begins to swell, and so on add
infinitum. What gets me is, where does the first blister go?
I need to ask the doctor about this when I go on the January 5,
2006. How about that, we are nearly to the two year anniversary
of the hole in the bottom of my foot. I suppose, it’s something to
look forward to.
Anyhow, back to the problem at hand. The blister covered by the
mole skin now ruptures out through the side of the blister, forming
a channel under the callous. The top of the blister seems quite
healed. I have one of those callous rasps the ladies like so much,
when the callous is dry I grind off the really hard parts of the
callous making very sure not to touch the little crater where the
blisters form.
December 21, 2005, Last night I had a chance to really see what
was going on with the blisters and all. I noted the blister is no
longer rupturing through the side of the wound but out through a
opening about an 1/8" long in the top of the blister. The opening
looks more like a cut than a rupture. By the way, to get the mole
skin to stick, do not remove the old adhesive. The new adhesive
bonds with the old stuff and the dressing remains in place.
December 29, 2005. The overall size of the thing on my foot is
shrinking rapidly. I think I owe it all to the Provant System
mentioned above. I’ve tried to stay off my foot but living alone is
no good for this kind of care. Even though I do a bunch of walking
on the foot with and without the special shoes, the wound
continues to shrink. Today for the first time in almost two years
there was no drainage from the wound. Say what you like about
Radio Waves, they work and I’m living proof of this.

The new procedure was explained as follows:
It is actually a post graduate training that both advanced practice nurses and some
physicians decide to specialize in.
Our kind of moist wound healing has been shown in thousands of research studies to be
superior to the traditional "wet to dry gauze" dressings, they have been using for 30+
years. Healing is 50% faster, non painful, and even cost effective because you change
dressings less often.
The new dressing is called, “Burn Antimicrobial Dressing” and is also known as
“Acticoat”.
The manufacturer tells people to set it with sterile water, but I have used it with tape water
for years, with good results. The “Nanocrystalline Silver” is activated by the water.
First you cut the silver impregnated “Burn Antimicrobial Dressing”, “Acticoat”, to a size
just a bit larger than the open wound.
Then the Burn Antimicrobial Dressing is dampened with tap water and stuck to the
opening of the wound. Sterile water is recommenced but few homes have hot and cold
running sterile water.
Then you cover this with a second layer of some material called, “Hydrafiber” this
dressing is also known as “Aquacel”. It also comes in a silver, antimicrobial dressing
called “Aquacel AG”.
This is not treated gauze, as it appears to be, but it is a synthetic fiber dressing that
becomes a gel when it comes into contact with wound fluid.
The Aquacel AG is in a sealed pouch and is not to be opened until you use it.
These two dressings are then covered with a special treated foam rubber pad called
“LYOFOAM” about a quarter inch thick. You need to be sure you get the right side down.
One side is a light pink and the other side is a cream color. If your color blind like I am,
the treated side has a slick appearance to it.
The whole thing is then taped in place by a special waterproof tape called “HYPAFIX”.
This is some sticky stuff and it’s hard to handle with one hand while holding all the rest of
the stuff in place on your foot.

I have found it’s best to stick the first two items to the open wound and then stick the tape
to the foam rubber. In this way you can fix the foam rubber right where you want it and the
piece of tape will then hold the whole assembly together on your foot. You might need a
second piece of tape depending on the size of the foam pad you’ve cut.
The first day I got a shock. When I pulled the tape off, the new skin around the blister
came off with it. The next day I returned to the tape method but I was careful to avoid
sticking the tape to any area looking pink.
This seemed to work quite well and I’ve been using this method ever since. If you use the
tape, be sure you cut the first few foam rubber pads large enough to cover any new, thin or
damaged skin.
Now please bear in mind, there is a second method of securing the dressing to your foot.
This second method does not use tape at all. The material is semi adhesive and stretches.
Great care must be taken when using “COBAN” as it is possible to pull it too tight and cut
off the circulation. If properly used, the stuff is a true blessing as there is absolutely no
danger of pulling the skin off.
As with any blessing, there is a dark side. Coban sticks to almost any other fabric.
In my case, I pulled my sock up over the dressing for the trip home. When I removed my
sock, the dressing came off with it and I spent the next several minutes separating my sock
from the dressing.
Although this new method seems to control the infection in the area, the actual wound
refuses to heal and there has been little change since the last picture was taken.
Then after my evening shower, I reapplied the dressing and Coban. By morning the
dressing was nowhere to be found. It had apparently stuck to the sheets on my bed and
come off my foot.
The cat had found it and made a grand plaything of it for the rest of the night. I found it
much later in the day on the kitchen floor near where I feed my cat.
The Coban works just great IF you heed the cautions mentioned here. It sticks to itself with
a tenacity requiring scissors to remove it. It does not stick to your skin. The material is so
self adhesive it’s difficult to find the end to remove it by unwrapping it.
The great problem is the ease with which one can wrap it too tightly. Great care must be
taken with each pass around the limb. This is no joking matter with diabetics. The speed
with which an infection can set in, even with a proper dressing, is alarming.
No matter what you use to cover an open wound, you need to make absolutely sure the
area is clean before you apply any dressing to it. There’s just no sense in inviting other
infections to an already weaken system.
This is where we are today, beginning of April to the end of October. Not pretty but true
and all diabetics need to take note.
The white spot is where the “stump” was.
The cracking of the skin between the toe and the ball of my foot seems to have healed. This
was very difficult to control.
As the new skin grew over the crack it immediately hardened and re-cracked the first time
the toe was moved. The problem was diagnosed as Athletes Foot and it responded well to
treatment.

Somehow the part about covering my toes was lost from the
directions and the foam rubber protecting my poor little toes was
lost in the translation and in the end I had to adapt the foam over
the toes with tape.
Anyhow I had three lovely ladies working diligently on my leg
for almost an hour. I couldn’t help but feel sorry for the lady
holding my leg in the proper position as about half way through
the process her hands began to tremble.
The leg with all that stuff on it must have gotten very heavy quite
rapidly as layer after layer of plaster and fiber glass were laid
on. She hung in there, bless her heart, and never once let my leg
drop.
I was supposed to be flat on my belly for the plaster part but the
only flat surface around was the floor. Still, as I helped from time
to time by reading the directions, the operation was a complete
success. It is said this cast thing should heal the ulcer in a week
or two and they change the cast next week and then again the
week after. I’m going to mark the cast with dotted lines where the
saw is supposed to go, just in case.
This was the second cast of this type to be used at the Lake City
VA Hospital. The first one was put on a man who worked a horse
far. From what I understood about it, he managed to break the cast
in half and fill it with manure.
One of the ladies came all the way from Valdosta to learn how to
put one of these casts on. It was this luckless lady who wound up
holding my leg in the proper position.
I was just lucky enough to be handy so they used me as a the test
subject. I think, when it comes to doing this again, I’ll have a few
suggestions on how to do it a bit better. The cast runs a bit high on
the back of the leg and quickly becomes uncomfortable when I try
to climb stairs in the thing. Going downstairs is a nightmare.
The lady holding my leg up apparently put pressure on the side of
the cast as it hardened and there is an uncomfortable lump in the
Left hand side which makes sleeping on the left side very hard.
Oddly enough, driving with the cast on was relatively easy. I just
had to look down each time to make sure the foot was all the way
onto the clutch peddle.
Before the cast I had a big oversized padded shoe. It was just
wide enough to pick up the clutch peddle and the break at the
same time. This wasn’t too bad in traffic but on the highway when
shifting from 4th gear to 5th gear at 65 or 70 miles per hour. It did
tend to startle the drivers behind me.

DISCLAIMER:
THE ONLY FOOT USED IN THE PRODUCTION OF THIS DOCUMENT WAS MY
OWN FOOT. NO OTHER FOOT WAS EVEN CONSIDERED FOR THE PART.

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Although the picture is a bit fuzzy you can still see the red area
between the newly opened hole in my foot and the toes and on
over the side of my foot. The red area seems to origionate at the
crease between the ball of the foot and the hole.
It could be the Athletes foot I've mentioned previously. The tape
extended all the way over to the other side of the foot.
Anyhow, I took this picture on December 2, 2004.

In the evening, I removed the dressing to take a shower. There was a strange looking thing
growing up out of the newly expanded hole in my foot. For the life of me I couldn’t figure
out what it was or why it was growing there. I’d never seen anything quite like this before
except one time many years ago when an old splinter popped up out of my hand. The big
difference was the thing on my hand was sharply painful and bled a lot every time I
touched it.
I had finally gone to a local doctor and had the thing cut out of my hand. There seemed
nothing to it. He just shot some pain killer into the base of the thing and went to work with
his knife. The whole thing took no longer than ten minutes.
Naturally, with this experience in the back of my mind, I expected this thing on my foot to
do likewise. Oddly enough there was no pain associated with it, maybe because of the
Diabetic Neuropathy. Diabetic Neuropathy is the gradual diminishing of feeling in the
extremities and other less pleasant feelings, like Phantom Pain, the unpleasant burning
sensation in the Diabetic’s feet.
Diabetic Neuropathy, is the primary reasons diabetics must never go anywhere barefooted.
If you step on something sharp you simply don’t feel it. If this happens you’re going to
wind up in the same situation I find myself in today. Unfortunately, not only do you not feel
the cut, but you don't feel the infection either. This is why doctors recomend you CHECK
YOUR FEET EVERY NIGHT.
I called it, "The Stump" because it looked like a little tree stump growing out of the bottom
of my foot. I just had to take a picture of this intriguing thing. Note the dandy red color and
the swollen condition of my poor foot.
I sat looking at the thing for a while testing it for any feeling at all. In the end I took my
handy dandy Swiss Army Knife and pocket Surgical Tool.
Then I cut the stump off. I squeezed the scissors on the knife and mentally yelled
“TIMBER” as “The Stump” fell from my foot. I was expecting a blinding flash of pain
accompanied by gushing blood.
There was no pain or bleeding, not even a little dribble, and I thought I'd seen the last of it.
How disappointing, without a huge bloody bandage wrapped about my foot, how in the
world was I supposed to tell people of my trials and survival as a diabetic with a foot
problem?
Anyhow, the thing just wouldn't heal. I wound up at a "Wound Care Specialist" in Lake
City. By this time, things were truly getting nasty looking. Unfortunately I didn’t record in
this journal the first visit to Lake City.
Fortunately the lady who was charged with helping me survive my foot infection was a
lovely lady and we had great fun talking about my foot. Guys, this is a guaranteed ice
breaker.
Now I got an education on the very newest wound care ideas. Wounds are no longer
supposed to dry out. They are to be kept moist.
The new drill is called "Moist Wound Healing" or "Advanced Wound Care." Many
healthcare professionals don't understand it, because it is not taught in med or nursing
school yet.
Naturally the first thing through my mind, as a Neophyte to all this was, “Won’t this
encourage Gangrene?” The nurse tending my foot assured me it wouldn’t.

Things got progressively worse as time went by. There seemed to be something deep in
under the old blister trying to come out, maybe an old splinter or something from the days
before I was diagnosed with diabetes.
Infection flare-ups became more frequent and I gradually realized I was in big trouble with
the thing. I tried staying in bed to keep my weight off my foot and this may be one of the
reasons I still have a foot attached to my leg.
I went to a VA Surgeon at the V. A. Outpatient Clinic in Tallahassee, FL. and he removed
the callous from around the little hole. He then put and put a standard dressing on it.
The Doctor called the procedure a “Debridement”. The process removed the debris from
around the wound, as the Doctor explained it to me. The Doctor packed the wound with
conventional bandages and gave me a special shoe to put my weight back on my heel when
I walked.
Wearing this shoe while going up or down stairs is not for the faint of heart. The shoe
throws your balance off especially if you’re used to walking up stairs using the front of
your foot on the step.
Driving a car with a stick shift and clutch should be avoided at all cost. If you need to go
somewhere, take your regular shoe with you and wear it while you drive. At your
destination put the special shoe back on.

March 30, 2006. Today was not a good day at all. I went for my
regular appointment with Dr. Alexander in Lake City only to find
there was blood under the dressing on my foot. The outside looked
just great and the drainage had stopped.
Unfortunately, a large pocket had formed under the callous and the
whole top of the callous had to be cut away. Once again there was
talk of more radical methods of immobilizing my foot. I thought all
was lost and all the healing I’d done over the last six months was
out the window.
On returning home, I tried to take a picture of my foot, but it’s hard
to take a picture of the bottom of your own foot. The picture came
out fuzzy and doesn’t really show the depth or number of holes I
now had in my foot. There seemed to be three major areas of
destruction. The old spot being the largest and most visible, then
there was a new spot on the inside of my foot near where the
callous gives way to the skin on the side of my foot. This is where
what had been in the pocket had forced it’s way out and another
even smaller spot up toward the toe. I’m not sure which one it was
that had bled.
Fortunately there wasn’t much blood, but any blood at all was an
indication something was very wrong. This was the first time I’d
seen red blood in the area of the wound. It was kind of scary. I was
sure the worst was yet to come.
April 21, 2006. Today my foot is healed over and looking good. I’
m once again using the “Mole Skin” dressing with instructions not
to remove it until the dressing falls off on it’s own. Why the healing
was so rapid after giving both the doctor and I such a shock is a
mystery.
I had long thought the wound acted like there was something lodged
in there, but there was no evidence of anything on the X-Ray. The
wound had always looked as if there was a larger pocket just under
the callous, but I’m not a doctor and there was no way for me to
get a clear look at the bottom of my foot.
Then there was the possibility it was the Provant Wound Closure
System I had used the system as instructed and it seems to have
helped except for what looked like the pocket I mentioned above.
Last but not least, it was all the cures put together causing the
wound to heal over and bleed. The blood was a good clear sign the
tissue was healthy under the callous. Then when Dr. Alexander cut
the callous away, the wound healed from the bottom up the way it
should have, long ago.
I’ll never walk without a cane again, but at least I still have all my
foot. Any of you diabetics out there reading this, it can be done. It
takes some doing but it can be done and you don’t have to lose
your foot. Listen to your doctor and contact the Provant Wound
Closure System Pay attention to your diet and stay off your foot.
This last item is by far the most difficult thing to do. I live alone and
I’m upstairs to boot. If I can do it, you can too.
April 29, 2006; Last night there was intense pain in the area just
ahead of the wound in my foot. The pain centered in the pad of my
big toe. On a scale of 1 to 10 it would have been about 6. It was a
burning sensation like when a blister is pressed and separates the
skin around it from what the skin had been attached to.
I removed the “Mole Skin” dressing and found it was full of
congealed blood. As it was Friday, I tried calling the VA Hospital in
Lake City for advice as to what to do, but no one returned my call.
Not knowing what else to do, I put the Iodine Paste, Gauze and
tape back on the wound instead of the Mole Skin. The pain abated
and there is now a hardening callous over the wound.
Unfortunately, there is a pocket under the callous and I’m right
back where I was a couple of months ago.
June 26, 2006; Although the wound on my foot had given every
indication of having healed over, there seems to be continued
dynamic activity deep under the callous. A small crack, maybe a
quarter inch long, develops in the callous after some limited
walking. Living alone, there are times I need to get out and buy
things, this can’t be helped.
The area around the crack dries exposing pink skin at the bottom.
The callous continues to dry exposing a pocket of maybe ½ inch
across. This is accompanied by an extreme burning sensation in the
pad of my big toe and cramping at the arch of my foot. There is no
feeling in the callous at all.
The burning sensation is only momentary but the cramping can go
on a while and only seems to happen if the foot gets cold while the
pocket is forming under the callous. The burning sensation seems
directly related to the formation of the pocket and doesn’t bother
me at other times.
During my last doctor’s visit, I was told to discontinue the use of
tape over the area and to begin using a softening oil on the spot.
The oil was to be held in place by a small square of plastic wrap.
This doesn’t work very well as there is nothing to hold the plastic
wrap in place except more tape. If I use the tape alone, moisture is
held against the callous and the oil and plastic wrap are redundant.
09/04/2007: The ulcer continues to frustrate all efforts to
completely heal it. It's the size of a pencil eraser, but it just doesn't
seem to want to heal over.
Recently I had a problem with the ulcer bleeding. Giving this careful
consideration, I thought I might be taking too much Aspirin. I
stopped taking any Aspirin and the bleeding stopped almost over
night.
Also noteworthy; I've dropped to 210 pounds and cut my use of
insulin back to 10 units a day. My blood sugar continues to run in
the area between 70 and 120. When my last blood work came back
from the VA Lab there was, "GOOD" written in every category.
I'm kind of proud of myself.

December 8, 2004. Today was not a good one. The infected area
has neither grown nor shrunk. Again I’m told, if the infection can’t
be dealt with, there is a good chance I’ll no longer be classified
as a Bi Pod, I’ll be a Mono Pod, for the rest of my life. This is not
exactly what I had in mind for Christmas.
Anyhow, I did learn some new stuff for all the diabetics of the
world. If you do happen to get an infection like mine, don’t wait,
jump on it right then and kill the thing before it becomes chronic
like mine did. At this point, I’m not to use any kind of strong soap
to wash the infected area any more.
Hot showers are a thing of the past for me. As my feet are
insensitive to pain I have no way to gauge if the water is too hot
and I’m advised to err on the side of cool water.
Should you be given an Anti Biotic, they are best taken at night so
you can sleep through all the sounds made by the dying germs.
It seems, when I take a shower now, I must put my foot into a
plastic bag with saline solution and tape it to my leg. I sure hope
no one ever gets a picture of me so dressed. NO! I will not post
one on this web page.
It would seem, "The more harder I try, the more behinder I get." I
almost felt I was about to be introduced to the resident surgeon,
Dr. Choppa DeLegoff. Fortunately, this particular meeting has
been postponed for another time.
December 22, 2004 Good news today. The hole in the bottom of
my foot seems to be on the mend. There was only a little
discharge from the wound and it did not saturate through the
bandage as it used to do. I’ve been advised; I’m not yet ready for
any marathon walking competitions but I’ll be on both feet a bit
longer.
I’m to continue taking the, GATIFLOXACUN 400NG TAB and
covering the wound as I have been doing in the past. Mrs. Jones
cut more dead callous away from the opening and told me how
happy she was to see her Moist Wound Care Treatment was so
effective.
July 14, 2005: Today was a big day in the salvation of my foot. I
was put into a cast running from the tips of my toes to the knee.
Then, taking the bull by the horns, I slid myself cast and all
behind the wheel of my car and drove home. This was no mean
feat as I drive a stick shift or standard transmission.
Anyhow since April of 2004 to now July 14, 2005, this darn thing
refuses to heal over. This cast made of plaster and fiberglass is
supposed to be the latest word in off loading foot wear. Is it not a
work of art? It has a special rubber tread on the bottom that is to
load my weight in the instep rather than the ball of my foot where
the ulcer is.
Pictured next to the cast is the walking stick my son made for me.
He will custom cut any walking stick to your specifications. Take
a look at his page on this site, The button to click on reads,
"Robert P. Herbst Jr."