Over five million Americans are affected each year by at least one type of chronic wound, and the incidence of these wounds is increasing at an alarming rate of over 10% a year. Over 25 billion dollars is spent annually by the Center for Medicare and Medicaid Services on wound healing in the United States.  However, the true cost in morbidity, loss of quality of life, immobility, lost wages and even death cannot be calculated in dollars. 
    These wounds occur primarily in the elderly, disabled, and especially those with diabetes, who comprise the vast majority of those who suffer from pressure ulcers, diabetic foot ulcers, and venous leg ulcers.  The most unfortunate statistic of all, however, is that if preventative measures were instituted prior to the development of problems and, when problems do occur, treatments were implemented in a timely and rigorous manner, the majority of this morbidity and mortality caused by these wounds could be avoided.
    The science of wound care incorporates knowledge from many disciplines, up to 28 different professions by some estimates. These would include internal medicine, endocrinology, podiatry, dietary specialists, nurses, physical therapists, vascular surgeons, infectious disease specialists, and many more. The wound care specialist must incorporate and apply the entire range of disciplines necessary to understand and treat every chronic wound encountered. 
    The goal of anyone involved in chronic wound care should be to heal 100% of the wounds encountered without loss of limb or life.  While this may not be attainable at this time, the revascularization procedures and new wound care products and treatment methods that have “exploded” onto the scene in the past few years has made this a dream of every specialist involved in chronic wound care. By incorporating many of these disciplines and newer methods, most diabetic foot ulcers should be expected to heal in the absence of ischemia (absence of circulation) or osteomyelitis (bone infection).
    In the next several issues we will discuss the causes, prevention and treatment of chronic wounds.
Why is it important to treat thick nails and athlete’s foot in a diabetic?
     Statistically, anyone who has a fungus nail or athlete’s foot has three times the chance of developing a diabetic complication, such as an ulcer or cellulitis. In one study published at the 20th World Congress of Dermatology in 2002, it was found that 82% of patients with bacterial cellulitis also had a fungus infection. Another 1993 study of 680 HMO members revealed that patients with fungus infections had significantly poorer self-ratings with respect to pain, general health, physical appearance, functional limitations, and social functioning. 
    Athlete’s foot can cause a disruption of skin integrity acting as a portal of entry for bacteria such as Staph or Strep.  Also, the nail can act as a reservoir for infection to spread elsewhere.
    Treatment for fungus nails varies depending on the length of time and severity. Treatment may include oral medicine, local application of medicines, or very often, a combination of the two. If the nail is extremely thickened, it may have to be excised so the medication can penetrate to the origin of the infection.
    In conclusion, everyone, especially diabetics, should realize how important it is to treat fungus nails and athlete’s foot. All too often diabetics will contact a health care professional immediately to treat a bacterial or viral infection, yet wait many days, months, or even years to treat a fungus infection.
    In our next article we will discuss the important topic of pressure ulcers – prevention and treatment.