What is a Foot Ulcer?
A foot ulcer is a damaged area on the foot that either does not heal or keeps returning. A breakdown of the skin or tissues results in an open sore that can become infected. As well as the visible sore, you can experience pain, swelling, and a burning sensation.
Causes and Common Foot Ulcers
There are many causes of an ulcer. The most common foot ulcer is below. Foot ulcers can be caused by a vascular disease, namely chronic venous insufficiency (venous ulcers), Peripheral Arterial Disease (arterial ulcers), and nerve damage .
Arterial Ulcers - Arteries carry blood from the heart to the rest of the body. In some cases the arteries become narrowed by plaque. This condition is called peripheral arterial disease, or PAD. Severe PAD prevents the skin and tissues from healing properly due to a lack of blood supply. Even minor skin damage like an accidental cut or callus can result in an arterial ulcer.
Venous Ulcers - Veins return blood to the heart from the legs and the rest of the body. Veins can be damaged, blocked, or allow the backward flow of blood. Severe venous insufficiency causes blood to pool, instead of circulate, resulting in open sores that are slow to heal.
Neurotrophic ulcers - These wounds are the result of nerve damage caused by diabetes. These wounds typically occur on the bottoms of the feet and are hard to see and feel.
Risk factors of foot ulcers
Foot ulcers are more likely in older men, but the common risk factors for foot ulcers include:
- Poor blood circulation.
- Disease of heart and kidneys.
- Nerve damage.
If you ignore the ulcer, it can grow broader and deeper and become infected. Untreated foot ulcers reduce your mobility and can result in amputation in severe cases.
Signs & Symptoms of a Foot Ulcer?
A foot ulcer can be shallow or deep. When it starts, it looks like a red crater or dimple on the skin. If it becomes infected, it can develop drainage, pus, or a bad odor.
If you have nerve damage in your feet, then you won't notice the pain of a small stone, too tight shoes, or the formation of a foot ulcer. As you get older or have a medical condition like diabetes or Raynaud's phenomenon, it's best to check your feet regularly for damage and sore spots and consult your doctor.
Venous ulcers - Patients with vein ulcers may complain of swollen, tired, and achy legs. Venous ulcers are not typically very painful unless touched, or unless they are infected.
Arterial ulcers - Patients with arterial disease may complain of tingling, burning, or coldness in the feet or toes. Patients may also experience leg pain when walking, or foot pain when elevating the legs. Ulcers usually occur at the tips of toes or on the sides of the ankles or lower calves. The ulcer may look punched out with a yellow-brown or black color. They are often very painful unless there is nerve damage.
Treatment of Foot Ulcers
When you consult a physician about a potential foot ulcer, they will look at your foot and then assess the damage and treatment options.
Common Tests for Arterial Disease:
- Palpation with fingers - A healthcare provider feels the feet and ankles to sense any abnormalities in pulse pressures
- Wound culture- If your healthcare provider suspects an infection, they may need a sample from the wound to determine the type of bacteria involved
- Blood tests- You may need labs performed to look for evidence of infection in the blood
- Blood flow assessment - PAD could be preventing an ulcer from healing. Tests like arterial Doppler ultrasounds and ankle-brachial pressure testing may help make this diagnosis. You may also be offered an angiogram which is an xray of the arteries using an injection of contrast dye.
- You may need an xray, CT, or MRI to look for damage to bones lying under chronic wounds
Next, your physician will explore potential barriers to healing like:
- Foot abnormalities - claw foot, fallen arches,etc.
- Circulation issues.
- Nerve damage.
- Gait abnormalities
Step-by-step guide to treating feet ulcers
The treatment options depend on the state of your circulation, the severity of your ulcer, and your general health. Your doctor will encourage you to have a proper diet and maintain weight control.
Controlling the infection is a critical first step along with oral or intravenous antibiotics. Surgery may be needed to drain pus or remove infected tissue.
If you have good circulation to help with healing, your doctor may choose to trim away diseased tissues and calloused skin. To cure or prevent infection, you may also need antibiotics.
A dressing keeps the area clean, and it is likely to be held in place with a compression bandage. You may also need to wear specialist footwear or a cast to protect the foot from pressure in the ulcerated area. There are several types of dressing a physician can prescribe depending on how the ulcer appears and drains.
The treatment may take anything from a few weeks to a couple of months. A nurse changes the dressing every couple of days, and your doctor will set up regular appointments for inspection and further debridement.
After your ulcer heals, your doctor will advise on maintaining your feet and preventing future ulcers.
Interventional Procedures and Surgery
In the absence of adequate blood flow to promote healing, you may need a procedure to remove blockages in your blood vessels or reinforce damaged areas. Before recommending surgery to deal with your foot ulcers, your physician will explore the level of damage to your veins and arteries.
Shallow foot ulcers with good blood circulation typically heal within 12 weeks. There is a risk of repeat ulcers in a third of all healed foot ulcers due to a lack of preventative and corrective measures.
Deep ulcers with severe infection and poor circulation may require surgery and a longer time frame for healing.
Treating Venous Ulcers
The treatment regime for a venous ulcer involves compressing the leg to reduce swelling. The options for compression include:
- Compression stockings,
- Multi-layer compression wraps.
- Wrapping with ACE bandages.
Before the compression treatment, a cleaned ulcer is dressed depending on the treatment needed:
Alginate - absorbent, promoted autolytic debridement. Made from derivatives of seaweed.
Antimicrobial - manages infection and reduces bacteria at the wound site.
Collagen wound dressings - provides an alternative collagen source.
Composite - These versatile dressings provide a barrier to bacteria and other contaminants, while offering a simple “Band-Aid” type application and removal.
Debriding agents - The primary goal of debridement is to remove all the devitalized tissue from the wound bed to promote wound healing.
Hydrogels - encourages healing in moist wounds.
Moist - Moist wound healing is the practice of keeping a wound in an optimally moist environment in order to promote faster healing.
Synthetic skin substitutes - Skin substitutes are a heterogeneous group of biologic, synthetic, or biosynthetic materials that can provide temporary or permanent coverage of open skin wounds.
Treating Arterial Ulcers
The treatment regime will depend on your general health and circulation. Minimally-invasive procedures are most likely with this type of ulcer to promote better circulation and healing.
Preventing Foot Ulcers
Vigilance and good hygiene are the best ways to prevent foot ulcers and detect them in the early stages where the prognosis for treatment is excellent.
Make it as much a part of your routine as combing your hair and brushing your teeth to give your feet a daily inspection. You are looking for cracks, callouses, rubbed areas, and any damage. If you have poor eyesight and lack flexibility, enlist some help, use a mirror, and consider using magnification. Pay attention to the heel, sole, and between your toes.
Wash and dry your feet daily. Use mild soap and warm water. Dry between your toes and moisturize dry areas (never between your toes). It makes sense to combine the daily wash with the daily inspection.
Trim your nails straight across or keep them short with an emery board.
Invest in shoes that fit well and don't apply pressure or rub. Your soft, absorbent socks need to fit well and not be too tight. Change your socks frequently to avoid your feet becoming hot or sweaty. High tech socks with antibacterial protection may help keep your feet fresh.
What to expect after treatment with CVM?
At the Center for Vascular Medicine, our mission is to help patients with their vascular diseases in a cost-effective and compassionate manner. We specialize in the diagnosis and treatment of venous and arterial diseases in the legs, feet, and pelvis. Our world-class providers are the most experienced in the specialty and work with patients to develop a treatment plan that is custom tailored to their unique situation.
Typically, this process involves an initial consultation and ultrasound scan at one of our accredited facilities. After reviewing the results of your scan and obtaining a thorough medical history, our providers will discuss the results with you and help you decide on next steps.
Our health care providers use several diagnostic tests to help determine what vascular diseases may be causing your symptoms. Our initial evaluations utilize ultrasound because this non-invasive imaging modality helps us verify our suspicions on whether your symptoms are caused by underlying vascular disease.
Latest research on treating foot ulcers
The problem with a nonhealing foot ulcer, especially in diabetic patients, is that it is challenging to remove diseased tissue and promote healing. For 70 years, maggots have served as a last resort wound treatment because medicinal maggots secrete digestive enzymes that dissolve dead tissue but leave the healthy tissue untouched. These enzymes also promote healing in healthy tissue. Before the discovery of antibiotics for infection control, maggots were an effective and efficient clinical tool.