Acute vs Chronic Wounds

Wounds can be classified into two broad categories, acute and chronic, based on time to heal and cause of the wound. Medically, the term “acute” refers to a sudden onset of symptoms, illness or injury. Acute wounds most commonly occur because of surgery or trauma and heal in a timely, organized and predictable fashion. Conversely, chronic wounds are characterized by delayed healing and inability to progress through the expected, orderly healing trajectory. 

Successful wound healing has four distinct phases: hemostasis, inflammation, proliferation and maturation, and takes two to four weeks. Hemostasis, the first phase, occurs immediately after wounding through blood vessel constriction and clot formation. This stage of healing lasts up to two days. The clot and wounded tissue release chemical messengers, signaling the migration of immune cells that clear bacteria and cellular debris. This is known as the inflammatory phase and lasts three to five days. These cells also initiate the tissue repair cascade which begins the proliferative phase. In this third stage of healing, various specialized cells promote new blood vessel growth, collagen synthesis and granulation tissue formation which develops into a provisional matrix of reparative dermis. This process is called re-epithelialization. The inflammatory and proliferative phases overlap and generally lasts five to fourteen days. In the final phase of healing, maturation, the newly generated epithelium matures and remodels to approach the architecture of the normal surrounding tissue. This process begins around fourteen days and can take up to two years to complete, depending on the degree of tissue destruction.

Although no exact designated timeframe exists, wounds persisting greater than six weeks duration are considered chronic. Failing to progress through the four phases, the wound stalls in an inflammatory cycle and cannot enter the proliferative stage. The most common reason is underlying disease processes like diabetes, venous insufficiency, decreased circulation or obesity. Other factors known to delay wound healing are bacterial load and certain medications. 

 Fortunately, wound specialists exist to help patients identify causes of chronic wounds and ways to overcome them. The therapeutic partnership between wound specialist and patient unlocks the door to sustainable health habits that can correct systemic disease. Additionally, through advanced wound dressing selection and tissue grafting, the microenvironment of the wound is optimized, and healing becomes possible.

If you or a loved one has a chronic wound, schedule your consultation with our wound specialist today!

Let us restore your balance.

If you notice the discomfort in your heels persisting, our trusted team of podiatrists at Balance Foot & Ankle can work with you to alleviate the pain by customizing a treatment plan to your lifestyle.

Schedule your appointment today!

At Balance Foot & Ankle, you hear us talk a lot about – you guessed it – feet and ankles. But given how interconnected your lower extremities are, it’s important not to overlook common ailments people experience in areas like the Achilles tendon and lower leg. Anyone who regularly runs, walks, or plays repetitive impact sports has likely dealt with pain in the area just above the ankle.

Here’s what you need to know about Achilles tendonitis and shin splints.

What is Achilles tendonitis?

The Achilles tendon is the band of tissue that connects the back of your heel to your calf muscles. It plays an important role in any physical activity involving your feet, and any sudden increase in activity level or intensity can cause this area to become inflamed. If the pain isn’t too serious, it can likely be treated effectively at home by decreasing activity levels and treating the tendon with ice, compression, and elevation.

What are shin splints?

Similar to Achilles tendonitis, shin splints tend to impact anyone who spends a lot of time on their feet or upon suddenly increasing physical activity. Shin splints typically involve feeling tenderness or pain (can be sharp or dull) along the side of your shinbone. At first, the pain might not be that serious and can subside after stopping exercise. But over time, if you don’t allow time to rest, the pain will likely intensify and you increase the risk of it turning into a stress fracture.

What you can do to treat and prevent these injuries?

If pain in your Achilles and shin persists for more than a week or two after resting, it might be time to see a doctor. More serious and complex cases may involve advanced diagnostic testing that will determine if surgery or an extended recovery period are needed.

To avoid Achilles tendonitis and shin splints, always increase your activity levels gradually. If you’re just getting into running, for example, start off slow and keep your runs short until your body is used to the impact. Proper footwear is also key – make sure you have shoes that fit properly, are designed for the activity you’re doing, and aren’t overly worn.

In addition to these precautions, strengthening your feet and ankles can help build a more durable Achilles tendon. Each of the muscles and tendons below your knees are highly dependent on each other, and a weakness or imbalance in one area can sideline you from your favorite activities if you’re not careful. When it comes to improving strength and mobility, check out our “Yoga for Foot & Ankle Strength” article to learn more.

Let us restore your balance.

If you notice the discomfort in your heels persisting, our trusted team of podiatrists at Balance Foot & Ankle can work with you to alleviate the pain by customizing a treatment plan to your lifestyle.

Schedule your appointment today!

If you’ve visited a doctor or specialty practitioner in the U.S., it’s likely been through a large hospital system. This model has brought healthcare to scale to meet the growing and evolving needs of patients across the country. While this type of healthcare has its upsides, many providers and patients have found that this system often stifles personalized and compassionate care.

From rushed and impersonal doctor visits to the dreary feeling of a large hospital or doctor’s office, patients have plenty of reason to dread healthcare appointments. In response to this, there’s been a budding demand for independent healthcare providers who can take the time to give each patient the individualized attention and care that they deserve.

This is what ultimately inspired Dr. Jennifer L. Prezioso in 2017 to create a unique patient experience that blends hospitality and compassion with medicine and surgery, all within a contemporary yet warm environment. Dr. Prezioso has pursued this mission through founding Balance Foot & Ankle.

To better understand what drives Dr. Prezioso and the benefits of independent practices like Balance Foot & Ankle, she sat down to answer some questions that speak to this.

What motivated you to start your own practice?
It has always been my passion to develop a patient-centric approach to patient care delivery that is aligned with modern healthcare and wellness. I wanted to provide an environment where patients could expect high-quality care with a focus on hospitality, compassion, and empathy. Part of my goal was also to make this model accessible to a broader range of patients in a larger geographic area. We started in Lakewood and now have a total of six locations in Northeast Ohio. We have 12 incredibly well-trained physicians and surgeons who all subscribe to and thrive in an independent model of healthcare delivery.

What inspired you to open an independent practice?
I had previously been practicing for several years in a hospital setting and was starting to desire to feel a little more connected with my care team and patients. I wanted to develop an organization that offered what patients were missing from a larger institutional healthcare setting. Although private practice has many challenges, especially competition from ever-growing and integrating health systems, there is something very rewarding about choosing your colleagues and choosing like-minded partners. We are a close-knit group that supports one another and ensures that each patient has the most personalized and individualized care possible.

What makes independent practice different?
One of the beautiful things about independent practice is the autonomy that each physician has to develop and hone their particular skills without a lot of administrative burden and bureaucracy. Although all physicians and surgeons in one specialty are likely trained very similarly and subscribe to similar protocols and algorithms for treating common pathology, all are unique individuals with their own finesse and bedside manner. Each has their approach to developing and cherishing their physician-patient relationships and how they choose to deliver their care effectively. This is going to result in more effective care, better outcomes, and more satisfied patients.

How does Balance Foot & Ankle prioritize patient care?
First and foremost, we ensure that we are accessible to patients who need us, which is why we offer same-day or next-day appointments for urgent issues. Our team also provides a comprehensive and multidisciplinary approach to care, recognizing that we may be treating patients with complex pathologies that require working alongside other specialties to effectively treat them. We utilize modern, innovative, and advanced treatment options to ensure the best possible outcomes for our patients.

How does Balance Foot & Ankle effectively communicate and engage with patients?
Patient engagement and communication are always a priority. In some regards, our patient communication is very similar to an institutional healthcare system in that we are integrated into the Epic EHR and MyChart platforms, enabling us and our patients to have timely access to information, results, and communications. We also offer telemedicine visits, translation services, and have an after-hours call center so that at least one of our surgeons is on call and available 24/7. We also make every effort to ensure that when a patient calls or emails, they speak to a human or get a call back as soon as possible that day. Since each office has a very close-knit staff, if a patient calls and has a question for their doctor, it’s often as easy as putting that patient on hold for a moment, walking back to ask the doctor that question and the patient gets a response immediately. That is truly a benefit that we see from a smaller independent practice.

Describe the importance of flexibility in patient care?
Because we are independent, we can be more flexible. For example, maybe we need to add a few patients who can’t wait until the next day to be seen. We may need to stay longer in the day or start earlier. In most instances, we can find ways to make these changes happen as our staff is always willing to be flexible. Our physicians want to take care of people who need us when they need us.

How does Balance Foot & Ankle foster a healthy work-life balance?
It’s important for physicians to strive for a healthy work-life balance. Although our profession does sometimes require after-hours calls, emergency surgeries, or catching up on paperwork and charts after business hours, I do encourage our physicians to make work-life balance a priority. This is going to prevent burnout, and ultimately be a happier and more satisfied version of themselves. In many ways, independent practice allows the autonomy of the physicians to create a schedule that works for them and their families.

How do independent practices adapt more quickly to evolving medical practices?
When we need to change or evolve our policies and procedures, such as trial new technologies or products in the office, we can do this on a smaller scale without a lot of the administrative burden, bureaucracy, or layers of compliance that may exist in an institutional setting. Our team can come together and decide what is ultimately best for patient care and our practice as a whole.

What is Balance Foot & Ankle’s philosophy and approach to patient care?
When we think of the framework for healthcare delivery conceptually, there are four levels. The first is the individual patient which is at the heart of this model. The next level is the care team, which includes the physicians and mid-level providers, the patient’s family members and friends. After that, there’s the infrastructure and resources (clinics, hospitals, ASCs). Finally, there’s the environment in which we deliver healthcare, the conditions under which we operate (insurers, market regulators, policy, etc).

The political and economic environment is constantly changing, and as with all health systems, we can be impacted by these changes. What we try to do in our small microsystem is to focus on the factors and the outcomes in those innermost layers – meaning prioritizing the individual patient, care team, and clinical infrastructure. This is where I think private practitioners can shine and dial in on delivering individualized care to patients. This patient-centric model allows the patient to become an active participant in care delivery rather than a passive recipient.

What does the future of healthcare look like to you?
What we are seeing for the future in healthcare is a continued trend towards more outpatient services as well as more healthcare delivery of service in the patient’s home. The real possibility is that the hospital bed of the future is in the patient’s living room, and the house call is a video chat.

We are also looking at a continued shift towards a value-based care model in which doctors and hospitals are rewarded or compensated for delivering high-quality patient care while attempting to decrease costs. The goal is to provide incentives for good outcomes and meet the needs of the patients.

Let us restore your balance.

If you notice the discomfort in your heels persisting, our trusted team of podiatrists at Balance Foot & Ankle can work with you to alleviate the pain by customizing a treatment plan to your lifestyle.

Schedule your appointment today!

As the prescription opioid epidemic took hold in recent decades, awareness has grown among medical professionals around the dangers of over-prescribing pain-killing medication.

This is evidenced by The American Medical Association 2021 report showing a notable decline in opioids prescribed by doctors, yet alarming levels of addiction and overdoses persist due to illicit drug use.

While the reasons behind this epidemic are complex and many, the corporate healthcare model has been one driver of this. The corporate healthcare experience often involves a high volume of patients coming to a provider, who typically receive standard and non-individualized care.

Fortunately at Balance Foot & Ankle, we’re not tethered to that model of healthcare.

Patients come to us for a range of conditions and injuries that are associated with significant pain, especially when surgical treatment is involved. That’s why all of our doctors and staff make every decision thoughtfully and with the side effects of any treatment plan top of mind.

When a patient comes through our doors, getting to the root cause of an issue is a priority. That means we don’t treat patients in a silo, rather we examine the unique, underlying factors contributing to a health issue. This helps inform a more personalized and comprehensive treatment plan that doesn’t rely on simply prescribing the problem away with pain medication.

But what exactly does personalized and comprehensive mean? At Balance, it means our team approaches patient care with a focus on people as whole individuals. For example, we recognize that a patient’s postoperative recovery from major injuries may require a different approach to pain management than another patient’s chronic or mechanical issues.

And while prescription pain medication is necessary and beneficial in some cases, such as post-operative recovery and significant trauma, we make efforts to help our patients comfortably transition to non-opioid pain management as soon as possible. This includes management strategies like acupuncture, exercise and movement, medical massage and cupping, physical therapy, cold and heat therapy, lifestyle changes, and much more.

With an aging population experiencing increasing levels of chronic pain, the United States is dominated by corporate, consolidated healthcare providers. But oftentimes, it’s the smaller, boutique healthcare providers that are able to offer the personalized and comprehensive medical attention and treatment needed. Schedule an appointment with us today.