Treating Extreme Diabetic Foot Wound PART 1 – FOOT HEALTH MONTH 2018 #21

Treating Extreme Diabetic Foot Wound PART 1 – FOOT HEALTH MONTH 2018 #21

Patient: It is for sure smaller, right? TB: It is. P: She has a small stick. TB: A small stick, yep. P: Like a plastic stick. and she put it in and she said it was less deep than before. I don’t know. But she everything she is putting in the computer. TB: Yeah, they, take the measurements. And she says they’re getting it’s getting smaller, right? P: Yes, that’s what she said. And I believe her, so. (music) TB: So, what I see is again, we have that yellow rim that’s closing in. We just need to make sure the depth comes up. We don’t want the hole to close from the top, but it’s still empty underneath. That’s the issue. So i’m happy that you got that bioabsorb. It’s good. So let’s scrape this down. So now it’s been a month and a half since you’ve been coming in or a month. P: Okay. TB: So not too bad. So again, anything that the dead has to come off. That white tissue will turn into a nice healthy pink tissue with time. P: Is someone… TB: Just the tv’s on. No ,it’s just you and me every night. So we see nice new tissue that’s forming on the sides. So I’m getting the hard callus off the top and then, we do the cleaning. This is the important part. What else have they said to you at that place? Not much? They just dress it? P: Not too much. TB: But they know you’re seeing me or not? P: Oh, yeah yeah. Yesterday, because every time is different girl right? TB: Yes. P: Yesterday was i saw her a long long time before. TB: So, we need, to make sure the wound edge is in line with the skin on top so everything closes in together. This, top part here, the wound, and the edge of the skin is together. On the bottom part, the skins growing faster and covering the wound. So we just have to clean up this bottom part a little bit more this top part is P: So the bottom TB: The skin on top it’s still deep still deep it’s not filling in and that’s why this hard skin on top is coming inside. It’s covering a hole, but the bottom is empty so it’s almost like a ledge. We don’t want to have a ledge. We want everything to be a nice circle closing in at the same time so this one’s going to need a little bit more cleaning on that bottom part. The top part is in line. So this one’s gonna need a little bit more cleaning today. But the top part is really not that shallow. I mean not that deep like before. This part is good it’s the bottom part that’s a little deep. So making sure that the wound edge and the skin are in line so, we don’t have like a ledge. We call that P: You mean the ledge on the bottom or the ledge on the side? TB: Ledge on the sides yeah. We call this undermining. We don’t want to have all this growth over and underneath there’s no real tissue. That’s what allows infection and things to grow. But the top one is okay. There’s not really any ledge. They’re tight together. Did you end up going for your appointment? P: For what? TB: With the specialist? I changed for the 3rd of May but I’m not sure I’m going there because that guy is TB: But you, did tell them that you weren’t coming in, right? P; No, I just change appointment for 29 of march to may 3rd. It wasn’t a problem. That’s the next available time when TB: They can accommodate you, yeah. P: Make an appointment. This specialist is doing the same as you, nothing else. TB: Well at the top part, it’s really connected which is good. It’s all the same level. Think of it like a slope, like a mountain slope. We want it to all be one nice smooth slope. P: So that’s why you are cutting the sides? TB: Yes, to make it connected with this P: To connect with the other tissue? TB: Exactly, exactly. So the top part is looking really good, we have a nice slope. The bottom I have to take a little bit more of the rim because it was kind of growing a ledge. We don’t want to have a ledge Because then what happens underneath the ledge, that’s where we can have bacteria grow. That’s how we get infection. That’s how we have more problems. Now the top is really nice and sloped nice.
It’s just bottom one, it has a little bit of this what we call a ledge or undermining. So I got to find where the wound edge connects to the to the wall. So next time, I want to see the work boot just to make sure that we make a nice that the padding is helping, okay, because your work, boots are one of the most important things that have to have a good cushion. P: So if i if i put the (?) So i have to put something under there this or just TB: The hole. The hole, would be a good start. P: The hole is the most important. TB: Yeah, just right over the spot so that way there’s not direct pressure on the wound, like a crater. So, what I can see happening is we’re gonna have the top part of the wound close in nice. It’s the bottom part that’s gonna take maybe a little bit longer but we have a nice slope. It’s gonna come in nice. But nothing, is digging into the into the joint. There’s no the the wound isn’t digging deeper. We can see the bottom of the wound. We just got to make sure that the right P: But you know it’s still leaking. That’s normal? TB: It’s an open sore. P: It’s not like blood. TB: Clear liquidish and that’s the P: A little, maybe a little but not too much. TB: What that is, P: Clear liquid is coming. TB: That’s the body sending fresh, new liquid for the cells to stay moist for the cells to move across the wound surface to reheal itself. Much healthier. The side are good. Okay, so i’m just gonna apply a little bit of pressure. So that’s the goal every time, we clean off whatever is dead, make sure that edges are sloped so nothing has a ledge and goes down. The top looks good. But you know looking at it I can see that the bottom is filling up because now I made it flat again. It was really bumpy and then I scraped it flat. So this is looking pretty good. The other two wounds have healed P: It is important to have it flat? TB: Yes, a flat yes yeah, we want the wound to just rise up like the sea. Nice and level and that’s why we want the sides also to be level with the wound so we don’t have to let P: You told me last time it wasn’t even. TB: It wasn’t, no. P: It was growing less than the other side. TB: Yeah, and we’re having problem with the with the bottom side, the part that’s this part of the wound. P: Yeah but you told, me that bottom sides not growing either. TB: No, no. P: Like scabs. TB: Exactly and that’s why the skin was almost growing over that area faster. So, now i’ve scraped it. It’s not perfectly flat but it’s more level. It’s not like, this anymore; it’s more level. P: Okay. TB: So what we’re gonna do P: If it’s growing, growing but not the same level TB: It’s okay, no, no it’s still okay, it’s still okay, yeah it’s still okay. But, we don’t, want it like this. P: Oh, okay. TB: We want to just even like, level, like that’s okay. It will just move up together. P: Okay. Yeah yeah.

100 Replies to “Treating Extreme Diabetic Foot Wound PART 1 – FOOT HEALTH MONTH 2018 #21”

  1. Jon, I can see why your patients love you and continue to come back. The way that you walk them trough everything as you do it so they understand what your doing is amazing. Thank you for showing your work with everyone!

  2. It looks so much better, before it was extremely deep. I'm diabetic and check my feet daily for sore spots, take care of dry skin immediately. I've learned a lot from watching you, thank you!

  3. HBOT soon??off loading? Packing? But I’m only at 2/3 way through but nice beefy red and good blood flowing boy look at the tip of the 2nd toe

  4. My sister has a wound on her big toe/left foot. It has been there over a year! she visits a wound clinic sometimes once a week up to 4 weeks between visits. She fears amputation. The blood is great as it represents living blood rich tissue.

  5. Wounds on the foot really inhibit one's life from staying off your foot at home to not being able to drive as this is his right foot. It's so deep!

  6. I'm a PCA and my client is almost done healing from one in this spot. Promogran matrix has been a miracle worker.

  7. Very interesting. What was the black dot on his second toe? I hope it wasn’t anything more than sock lint.

  8. Just love watching the toe bro but sometimes they're just a little too graphic for me. Couldn't watch this one all the way through.

  9. I love watching your videos, firstly because you're truly amazing to your patients and also because I feel this weird satisfaction while watching even though I have no toe or foot related issues, but I have this existential doubt peeking out every time I watch you perform this kind of follow ups, why can't the wound just be stitched inside out? I'm not a doctor nor a professional, just a curious kid.

  10. So patient again..and thank you for explaining undermining. I never could figure out why you made a would bigger. Seems like the wound is kind of like a pyramid with the base inside? So the slope needs better structure? Lol

  11. This is why long term care and home health nurses insist on inspecting feet. We really want to prevent these types of wounds. Great job Jon!

  12. How does this a occur? I have several family members who are diabetic never seen a wound like that. Did he step on something?

  13. Ya know Doc?, if the My Little Pony cartoon can call it's young male fans "Bronys", you aught to call all of your fans "Toenys". HAHA!! LOL!! I'll wear the label with pride!!

  14. So the man feels nothing there wow.. so it doesn't know it's there poor man. How do u keep it clean?

  15. I ask my co-worker that are diabetic to check their feet because of watching the Toe Bro and Dr. Nail Nipper. By the way thank you for information video

  16. Is he seeing someone about some off-loading that thing with some orthotic or something??? That is in one of the worst locations!!

  17. I love your videos you’re so compassionate with your patients a joy to watch I’ve learn so much…

  18. Great education me being a type 1 diabetic I look at my feet everyday. Although I have Charcot foot & osteopenia I do take care of my feet. My grandmother loss both legs due to no circulation of the blood. I remember them cutting a deep chunk out of her foot & there was no blood at all ..This is a great reminder to anyone to check their feet

  19. The tip of his second toe is looking much better, and I can definitely see the main wound is healing too!

  20. Hello, Toe Bro. I’m rather new around here- love your channel.
    Seeing this guy’s callus makes me wish you used some custom-sharpened steel, like the guy in these videos:
    I don’t know if you’ve ever seen his videos or not. They’re not the most legit or sanitary foot videos.


  21. I’m a huge fan. Seen all of your videos and I love your bedside manner and your interest in your patients care and comfort. Classic textbook wound care cleaning for new granulation tissue. Please keep doing this. We love your videos!

  22. It seems to be progressing well for his condition and complications. Fingers crossed for this one to continue improving.

  23. Okay so I dont know how this works but I hate blood very much blood on it's own makes me feel sick and as though I'm in danger meanwhile I can sit and watch a surgery an example is when I watched a man open up the body into the intestine and pull out grass (dogs intestine) or the multiple tumors being taken out or a neuter or spay I have watched… anyone have an explanation for this?

  24. Is this considered a pressure sore? Most people die within a year of getting them… definitely scary ;;

  25. I hate feet so much but I found myself binging these videos all night tonight omg, so strangely satisfying to extract or heal the disformed

  26. I watch your videos all the time and love how compassionate and willing to inform u are with your patients. A lot of Drs and healthcare workers feel like they went to school for a reason and don't share enough of their knowledge with their patients. It's not all of them but some. I do have to say I love watching surgeries and all kinds of gross stuff but the sound of you scraping the inside sent chills up my spine. Lol

  27. You deserve some kind of award for this. I don't see how you do it especially keeping such a good attitude about it all. All I can say is, good job and well done ✔

  28. When I was little my arm dislocated but it hurt alot.
    He had a wound and it doesn't hurt he's lucky UwU

  29. My sister is a diabetic and gets ingrown toenails alot and I try to tell her so often that she needs to watch them and see someone for it but she isn't one to listen very well. You do such an amazing job with all of your patients! I'm going to send her these videos so she knows what can happen if you dont take care of your feet.

  30. At first didn't realize why it was age restricted
    Watches till end

    Oh that's why 😮😮😮😮😮😮😮😮😮😮😮😮😮😮😮

  31. So nice amazing work by 4:41 I had to look away but I’m a bit sensitive but Jonathan great job

  32. As a diabetic I make bleeping sure my feet are in top shape. I've seen what happens when you don't and I will never be one of those people.

  33. I have ingrown toenail but its not that bad like some of toe bro patient i watch you're viedo all the way thru I don't flich when watching it interesting me you're so nice to every one who come to you you're doing a great job I don't actually have no one to help me with my ingrown toenail but its not as bad as you're patients

  34. You did a great job! Looks so much better since the first video. Please post another video of you shaving this callus.

  35. Nice to see it bleed. Diabetic neuropathy usually pairs well with peripheral vascular disease. I see beautiful granulation happening.

  36. Some jobs people do physicians thinks oh you be okay to work not realizing how the work interfere really with what they have going on. I know a physician can only give you so many days off but depends on the type of job you have really determines how long your progress takes to recover. Bless his heart will be praying for him!!

  37. I'm finding this content age restriction somewhat annoying. I have it disabled on my account, so that I can watch videos such as this. And yet, YouTube still prevents me from watching them.

  38. I wish I was in the states to do this procedure, here in South Africa we don't have such good pediotrist, been a diabetic for 20 yrs now and my ulcer is just getting worse

  39. Neuropathy is a bitch. Not feeling your feet hurt sounds like an oxymoron, but it’s not. Imagine 1 hr of sleep because your feet burn, tingle and feel like a kids inflatable toy. Not fun

  40. Please help I e had a diabetic sore on bottom of my foot for 2 years can't afford to quit work to stay off of it. Thanks

  41. I’m treating a similar wound in long term care and we don’t have a physical therapist to do sharps debridement in house at present. This yellow calloused area absolutely has to come off? The wound bed is clean , no stringy slough or Eschar. Minimal drainage. Foot only has contact with the area where the patient wears a foot and ankle brace while out of bed. Not weight bearing on that foot. Need revision from podiatry I’m thinking?

  42. My grandpa is 600+ lbs and has these on both his feet and when I lived with him I would come home from highschool and work and every night had to scrape away chunks of callused dead skin and then clean it all out, lotion his feet then had to bandage it all :/ . My grandma is in the hospital dying from terminal cancer and she was the one who always made him go to the foot doctor but now she can't and I don't live with him anymore so I can't check his feet often or schedule appointments for him and his feet and legs really worry me. His lower legs are horrendous and he has been getting feet ulcers for years from not taking care of himself

  43. I would really thank God for you !! If u can tell me whether my father leg is curable I can email you my father's report to you…

  44. Did you get it to heal toe bro Jo, not noticed a follow-up, did he lose his 1st metatarsal head or foot?

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