Diabetic Foot Files

227 Episodes

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Myiasis Explained: How Flies Target Wounds and How to Prevent Infestation

2026-01-3028:49

This episode explains myiasis (maggot infestation of wounds): how and why flies lay eggs in wounds, the lifecycle from egg to adult fly, risk factors (especially in diabetes), clinical signs, complications like infection, and urgent management steps. It also covers prevention strategies, differences between medical (sterile) maggot therapy and wild infestations, and practical advice on when to seek immediate medical care.

When Skin Sends SOS: Understanding the Kennedy Terminal Ulcer

2026-01-2820:39

This episode explains the Kennedy terminal ulcer: a sudden, rapidly progressing sacral wound often seen near end of life, and how it overlaps with pressure injury and skin failure concepts. Dr. G discusses the underlying physiology (perfusion collapse, inflammation, microthrombi), the role diabetes plays in lowering tissue reserve, clinical recognition, management focused on comfort and dignity, and the importance of clear documentation and family communication.

Felt Padding 101: The Low-Tech Offload That Heals Diabetic Foot Ulcers

2026-01-2813:48

In this practical episode Dr. G shows how felt padding — an adhesive-backed wool or synthetic material cut to create a pressure "donut" — can redistribute plantar pressure and promote healing of diabetic foot ulcers. He covers why offloading matters, supplies and step-by-step application, clinical evidence, a real case demonstrating substantial pressure reduction and healing, and common pitfalls with troubleshooting tips. Key takeaways: felt padding is affordable, customizable and effective when paired with proper footwear and monitoring; replace regularly and watch for skin breakdown or shifting.

Fusidic Acid — The Quiet Staph Assassin

2026-01-2619:47

In this episode Dr. G explores fusidic acid — an antibiotic isolated from the Fusidium fungus — its unique mechanism blocking elongation factor G, and why it became a powerful tool against Staphylococcus aureus in skin and wound infections. Dr. G covers clinical uses (topical creams, oral and IV when combined with rifampicin ), availability issues in the U.S., and why stewardship matters: short-term topical use only, culture-guided therapy, and avoidance of prolonged monotherapy to prevent rapid resistance.

Mupirocin Myths: When This Ointment Helps — and When It Hurts

2026-01-2618:49

Dr. G explains what mupirocin ointment actually treats, when it is appropriate for diabetic foot wounds, and why overuse can cause resistance. Learn its mechanism, limitations (no gram-negative, anaerobic, biofilm, or deep-tissue activity), proper indications for superficial gram-positive infections, and common mistakes that delay effective care.

“The Soaking Myth/ Urban Legend “ No Soaking: Why Warm Water Can Ruin Diabetic & Ischemic Foot Wounds

2026-01-2426:54

In this episode Dr. G, a podiatrist and limb-salvage advocate, debunks the common practice of soaking diabetic and ischemic foot wounds. She explains how warm water and salts cause maceration, strip the skin barrier, increase edema and bacterial growth, worsen tissue hypoxia, promote biofilms, and accelerate necrosis—especially dangerous in critical limb ischemia and neuropathic feet. Dr. G outlines safer care: gentle cleansing with saline or wound cleanser, pat dry with sterile gauze, protect the peri-wound skin, and seek vascular and wound-care assessment rather than soaking.

Comfort Over Closure: Managing Wounds at End of Life

2026-01-2313:00

Dr. G explains how wound care changes in hospice: the focus shifts from closure and aggressive treatments to comfort, pain relief, odor and exudate control, and preserving patient dignity. The episode reviews the physiology of dying skin, common hospice wounds (Kennedy terminal ulcers, unavoidable pressure injuries, ischemic/gangrenous wounds, and fungating tumors), and practical strategies like minimizing painful dressing changes and prioritizing symptom management. Dr. G emphasizes ethical care, family education, and the importance of treating patients with presence and compassion—honoring the body’s process while protecting comfort and dignity at the end of life.

It’s Not A Miracle, It’s A Marathon- Limb Salvage Revolution: Consistency Over Miracles

2026-01-2223:32

This episode reframes limb salvage as a marathon, not a miracle—arguing that persistent, team-based care prevents many unnecessary amputations and protects patients' lives, function, and dignity. Dr. G explains the scale of the problem, why amputations are often a system failure, and the five pillars of successful limb salvage: persistence, consistency, knowledge, team-based care, and patient empowerment. Key principles include vascular assessment before amputation, offloading, infection control, and timely referrals. The episode calls for ethical decision-making, better access to modern wound care tools, and patient advocacy: slow, consistent medicine over rushed amputations, and second opinions when limb salvage options haven’t been explored.

Pink but Perilous: Why Color Doesn’t Mean Healing

2026-01-2213:52

In this episode, a clinician explains why a pink wound isn’t always healing and why exposed tendon makes a wound high-risk and potentially limb-threatening. Takeaways: wound size and depth predict outcomes more than color; exposed tendon risks desiccation, infection, and functional loss; chronic wounds need reassessment and a new plan if they don’t improve within weeks.

Stop Leaving the Pinky Toe: Why Incomplete TMA Amputations Fail

2026-01-2024:18

Dr. G explains why leaving the fifth digit after other forefoot amputations creates biomechanical imbalance, increased lateral pressure, and recurrent ulcers. He reviews the muscle and tendon changes that drive varus/supination bias and lateral overload. The episode covers when a full transmetatarsal amputation (TMA) is preferable, the importance of adjunct procedures like Achilles tendon lengthening, and post-op management including orthotics, AFOs, rocker soles, and rehabilitation to restore balanced gait and prevent reulceration.

Questions That MUST Be Asked Before the Cut: 12 Questions to Ask Before Any Amputation

2026-01-1922:49

This episode explains why limb salvage is a philosophy, not just a procedure, and gives the essential questions patients and clinicians must ask before consenting to a lower-extremity or digital amputation. Topics include global amputation rates and mortality, distinguishing infection from ischemia, the importance of vascular assessment and revascularization, diagnosing and treating osteomyelitis, proper offloading and advanced wound-care strategies, and assessing metabolic healing capacity. The host also covers when amputation is lifesaving, alternatives to amputation, informed consent, and practical steps to ensure a thorough, multidisciplinary approach to preserving limbs when possible.

Size Matters- Size Is King: How Accurate Wound Measurement Saves Limbs

2026-01-1828:46

This episode explains why precise wound sizing—length, width, depth, surface area, volume, undermining and tunneling—is the most important metric in wound care. Dr. G covers practical measurement techniques, common mistakes, and devices to improve consistency. Key takeaways: always document depth, use disposable rulers and sterile probes, measure baseline and weekly (pre/post debridement), and escalate care if size doesn’t reduce sufficiently within weeks. Size changes, not vibes, predict healing and limb risk.

Auto Amputation and Demarcation- When the Body Cuts You Off: Understanding Auto-Amputation

2026-01-1822:41

In this episode Dr. G explains auto-amputation — when severely ischemic tissue becomes irreversibly necrotic, the immune system walls it off (demarcation), and the dead segment desiccates and may spontaneously detach. You’ll learn the step-by-step mechanisms from loss of blood flow and ATP depletion to fibro-inflammatory border formation and bone resorption. We also cover why demarcation is not healing, how infection can convert dry gangrene to dangerous wet gangrene, and when urgent vascular care is needed to prevent limb loss or life-threatening complications.

Wheelchair Wounds: How Sitting Can Cause Diabetic Foot Ulcers

2026-01-1727:40

This episode explores why wheelchair-bound diabetic patients are at high risk for foot ulcers despite not walking. It explains how static pressure, neuropathy, contractures, and poor positioning concentrate force on the heels, lateral toes, and dorsal toes, leading to deep, hard-to-heal wounds. Dr. G covers common ulcer sites, pressure-mapping thinking, prevention strategies (heel offloading, padded foot plates, AFOs, daily inspection), the role of caregivers, and practical tips for limb salvage and early detection.

Talking Dirty With Me - Wound Care Edition- The Clinically Candid Wound-Care Language That Saves Limbs

2026-01-1733:21

Dr. G breaks down essential wound-care terminology and explains why precise medical language matters for diagnosis, treatment, and communication with colleagues. The episode covers types of cell death, infection descriptors, gas in tissues, depth and space terms, vascular terminology, biofilms, debridement techniques, and common board-style questions. Listeners learn practical phrasing to replace vague descriptions (e.g., "purulent exudate" instead of "pus", "chronic limb-threatening ischemia" instead of "bad circulation") and how accurate documentation can improve care and limb salvage.

The Black Toe Manifesto -Black Toe, Big Stakes: How to Save Limbs — Ischemia vs Embolism vs Cholesterol Emboli

2026-01-1530:28

This episode explains why a "black toe" is usually a sign of systemic vascular failure and breaks down the three main causes—chronic digital ischemia, acute arterial embolism, and blue-toe (cholesterol) syndrome—covering how each presents, key distinguishing features, essential diagnostic tests, and immediate management steps. Takeaway actions include calling vascular early, avoiding premature amputation, initiating urgent anticoagulation for embolism when indicated, providing supportive care for cholesterol emboli, and preventing future events through diabetes control, smoking cessation, lipid management, and careful vascular intervention.

Diabetic Foot Care in Pregnancy: Treating Two Lives at Once

2026-01-1524:24

Dr. G explains how pregnancy alters diabetic foot care and why you must treat maternal and fetal risks together. This episode covers stricter glucose targets in pregnancy, safest imaging (ultrasound, MRI without contrast), preferred local anesthesia (lidocaine without epinephrine), recommended antibiotics (e.g., clindamycin), and cautions on CT, gadolinium, and long-term silver or iodine dressings. Key practical points include careful vascular and wound exams, prompt evaluation of puncture wounds and foreign bodies, multidisciplinary decision-making with obstetrics, and tailoring wound care and procedures to minimize fetal risk while managing maternal infection and ischemia.

Wound Farm: When Healthcare Rewrites the Rules

2026-01-1522:16

This episode uses George Orwell's Animal Farm as an allegory to examine how healthcare systems can prioritize profit, rules, and convenience over equitable wound care. Dr. G explains how delays, denial of vascular studies, and systemic bias lead to unnecessary amputations and worse outcomes for underserved patients. He outlines practical wound-care commandments—vascular evaluation, offloading, infection control, prevention, and persistence—and urges clinicians and patients to choose limb salvage over quick amputation. The episode emphasizes endurance, patient advocacy, and treating every limb as if it belonged to someone you love.

Skin Gardening 101: Grow Skin, Don't Just Treat Wounds

2026-01-1224:22

Dr. Gabby (Dr. G) the Skin Gardener reframes wound care as "skin gardening," explaining how skin regenerates layer by layer and why diabetic foot ulcers reflect a breakdown of the body’s ecosystem. She covers history, skin anatomy and cell roles, how diabetes disrupts healing (neuropathy, ischemia, infection), and why the basement membrane, fibroblasts, and perfusion are essential. Practical takeaways include the core needs for growth: oxygen and perfusion, offloading and mechanical protection, moisture balance, debridement, and replacing missing signals. She also previews future tools—stem cells, bioengineered skin, and personalized therapies—to cultivate better healing outcomes.

De Motu Cordis- Motion Is Life: How William Harvey Revolutionized Circulation

2026-01-1112:35

Dr. G traces William Harvey's discovery of blood circulation and shows how it transformed medicine and modern wound care. The episode explains why movement, pressure, and vascular health are essential for healing diabetic foot ulcers and outlines clinical approaches—revascularization, exercise, offloading, and glycemic control—that restore circulation and save limbs.

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