of blood-circulation and off-loading usually will result in healing.
It is important to recognize that with increasing age and weight of the population in the world
some of the conditions normally associated with diseases, as neuropathy and edema will
be present in normal persons. As a part of the normal ageing the sensation
in the feet decreases and is not uncommon (and therefor normal) that a person at the
age of 85 without diabetes can have a foot ulcer.
Obesity increases the tissue edema in the lower legs and as a result of this healing
is impaired in these persons even without venous insufficiency.
You might have noticed that I use the terms “ulcer” and “wounds” interchangeably.
Usually the term wound is used when the cause is externally applied, as in traumatic wounds.
The term “ulcer” is used when the cause is internally as a cancer ulcer. However in
the real world the chronic wounds have both internally and externally contributing factors
and the both terms apply.
Some chronic ulcers are by definition non-healing unless the underlying cause is eradicated
like cancer ulcers with chemotherapy or irradiation, yet new problems can emerge due to damage
by the treatment. In diabetes or venous insufficiency the underlying cause cannot be cured, but
most chronic wounds will heal when the basic principles are used. But some will not heal
despite this and one of the main causes in these situations is the presence of microorganisms.
Instantly, when a wound occurs, it is contaminated with microorganisms. Normally these microorganisms