Diabetic Foot Files

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 cleansi...

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 ...

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 vas...

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 includi...

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 wou...

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 s...

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 dr...

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 inspect...

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...

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 anticoag...

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 care...

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 per...

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 n...

This episode explains bone scans as functional, nuclear medicine tests that reveal bone metabolism—blood flow, inflammation, infection, and repair—often before structural imaging shows changes.

Learn the three phases (flow, blood pool, delayed), how osteomyelitis typically lights up all phases, pitfalls like Charcot foot and ischemia, and advanced options (SPECT‑CT, labeled white blood cell scans, PET) that improve diagnosis and gu...

In this episode we break down skin substitutes for diabetic foot ulcers: how they work biologically, why they are not interchangeable, and common errors clinicians make.

We review major categories and examples (bioengineered cellular grafts like Apligraf and Dermagraft; human dermal matrices like AlloDerm and GraftJacket; placental/amniotic products like EpiFix and Grafix; xenografts such as Integra; and synthetic matrices like OAS...

This episode explains that diabetic foot ulcers are driven by "biological paralysis" rather than just skin loss, describing the four phases of wound healing and why wounds get stuck in chronic inflammation.

Dr. G reviews key failure mechanisms—protease imbalance, fibroblast dysfunction, persistent M1 macrophages, angiogenic failure, and stem cell impairment—and how skin substitutes can replace extracellular matrix, rebalance cytoki...