Ulcers

Foot ulcers are open sores on the superficial layers of the skin that result from the breakdown of healthy tissue. Ulcers may remain on the outer skin or may go as deep as to expose the underlying bone. Effective treatment for ulcers is vital as they pose a risk for serious infections, which for the lower limbs has resulted in ulcers being one of the leading causes of amputation.

What causes ulcers?

Ulcers can occur due to a number of causes, both diabetic and non-diabetic. Often there is an associated medical problem or condition, so it is essential that this is uncovered and treated. Areas of high pressure over bones and joints can contribute to the development of all ulcers. They can be:

• Neuropathic
• Arterial
• Venous
• Pressure-related

Neuropathic ulcers typically occur where the sensation is partially or wholly lost from the feet. This often happens with diabetes but other conditions can cause neuropathy too. Neuropathic ulcers can progress quickly because they are often unable to be felt and so no pain- or pressure-alleviating measures are taken. These ulcers are often located on the bottom of the foot in any area that has high pressure. Arterial ulcers result from poor circulation and blood flow to the feet and legs. Insufficient blood to the tissues can cause tissue death and the development of these often painful ulcers. These ulcers often occur on the feet and lower third of the legs. They carry a higher risk of infection as circulation is generally insufficient to help clear infections. Venous ulcers occur from problems with the veins where they struggle or fail to complete their function of moving fluid away from the legs. This leaves the fluid to pool in the legs, resulting in leg swelling, and greatly increases the venous system pressure which then leads to ulceration. These ulcers are often seen around the lower legs and ankles. Pressure-related ulcers are often referred to as pressure sores and occur from prolonged pressure to an area of the lower limbs or body. This is often observed in those confined to their beds, where ulcers develop on the buttocks or the back of the heels. Often there are other associated conditions at play too.  

What are the symptoms?

Foot ulcers may be circular in shape or may have distorted edges. They start as a reddened area that blister, peel or crack to create an open wound. They often weep and may have some bloody discharge. The layers of skin become thin and the ulcer may expose bone, muscle or tendon. The edges may become brown/black or stay pink/red. If an infection occurs, the ulcer may have patches of yellow/green and may produce exudate and an unpleasant odour.  

How are ulcers treated?

Because ulcers put patients at risk of serious complications, it is important that ulcers are treated professionally and effectively. Treatment will depend on the cause of your ulcer and the contributing factors. Because of the often systemic nature of ulcers, treating the cause often involves looking at your overall circulatory issues, venous problems, and the management of diabetes where present. Your podiatrist will be able to:

• Debride the ulcer where needed to remove any dead tissue that is impairing the healing and repair process
• Identifying and helping you manage infection where present
• Off-load pressure away from the ulcer through pads, orthotics, footwear or total contact casting
• Liaise with other health professionals in the best management of your ulcers