Practical podiatry : . ofvaricose ulcers is usuallj^ easy; but the mere presence ofenlarged veins, it shouldbe noted, is not pathogno-monic, because they mayexist along with ulcers ofother origin—the luetic,trophic, etc. The most fre-quent complication isphlebitis; cellulitis is alsoseen. This latter maysometimes be so severeas to necessitate opera-tion. Complications suchas necrosis of bone, in-volvement and ankylosisof the ankle joint, to-gether with atrophy andcontracture of musclesand adhesions of ten-dons (perhaps givingrise to various deformi-ties of the feet, such asflat-foot or even cl
Practical podiatry : . ofvaricose ulcers is usuallj^ easy; but the mere presence ofenlarged veins, it shouldbe noted, is not pathogno-monic, because they mayexist along with ulcers ofother origin—the luetic,trophic, etc. The most fre-quent complication isphlebitis; cellulitis is alsoseen. This latter maysometimes be so severeas to necessitate opera-tion. Complications suchas necrosis of bone, in-volvement and ankylosisof the ankle joint, to-gether with atrophy andcontracture of musclesand adhesions of ten-dons (perhaps givingrise to various deformi-ties of the feet, such asflat-foot or even club-foot) are extreme andunusual complications. Where the varicose ulcers have persisted for a longtime and refuse to heal, it is always advisable to apply theWassermann test in order to exclude the possibility ofsyphilis. In doubtful cases it is also advisable to test by theNoguchi luetin skin reaction. Treatment. In these cases of varicose ulcers it is im-possible to effect a cure until the chronic congestion of the. VARICOSE ULCER 324 PODIATRY limb is relieved and the blood supply of the part ap-proaches normal. Often all that is necessary is a gauze,mnslin, rubber or flannel bandage. A bandage, when applied with moderate, even pressure,has for its purpose the relief of congestion. In a greatmany cases rubber has an irritating effect upon the skin,and that kind of a bandage should therefore be cautiouslyused. When the granulations are almost on a level with theskin, and also where there is considerable thickening of theedges of the ulcer, the best means of keeping up an evenpressure and causing absorption of the thickened margins,as well as of hastening epithelial growth, is to apply zincoxide adhesive plaster in strips, one-half to one inch inwidth. These strips should overlap to the extent of aboutone-third of their width, should extend about three-fourthsof the way around the limb, and should be evenly andsmoothly applied. They should be started about one inchbelow the u
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