Foot and Leg Ulcers | Specialty Care Clinics

A foot ulcer is a damaged area on the foot. Ulcers of the foot do not heal and keep returning. The open sores due to the breakdown of the skin or tissues become infected. This would lead to pain, swelling, and a burning sensation.

Foot and Leg ulcers mostly cause pain. Foot and leg ulcers due to nerve problems such as diabetes, you may not feel any pain. This might lead to leg infection as you tend to ignore the ulcer.

There may be other symptoms in your legs and feet including:

Heaviness
Large varicose veins
Pus, bleeding, and discharge
Swelling
Change of color

Foot ulcers typically appear due to suffering poor blood flow in the legs. People with diabetes are at high risk of developing foot ulcers, due to poor blood flow or less sensation in the feet.

Risk Factors

Other causes of foot ulcers such as:

Traumatic injury
Tumors
Infections
Vascular disease including stroke, heart attack, angina

The types of leg and foot ulcers are:

Arterial ulcers
Neurotrophic ulcers (diabetic ulcers)
Venous stasis ulcers
Arterial Ulcers: It is also known as ischemic ulcers. Arteries carry pure blood from the heart to all organs of the body. The arteries may become narrowed by plaque called peripheral arterial disease (PAD). In severe cases, the skin and tissues do not heal completely due to a lack of blood supply. Arterial ulcers appear mainly on the heels, tips of the toes, between the toes, or protruding bones. It might also occur when the socks rub against skin, shoes, or bed sheets. The ulcers appear yellow, brown, black, or gray, and surrounding skin look punched out. Arterial ulcers normally do not weep or bleed. Minor skin damage such as accidental cuts or callus can also result in an arterial ulcer.
Neurotrophic Ulcers: Also known as diabetic ulcers. These are common among people suffering from diabetes. These can also occur in anyone who has lost sensation in the feet. These ulcers are caused by either trauma or increased pressure points at the bottom of the feet. The ulcers can appear pinkish-red or brownish-black depending on the blood circulation. The surrounding skin is usually calloused and the borders of the ulcer are punched out. Nerve damage in the feet is the main cause of loss of foot sensation. The changes in the sweat-producing glands increase the risk of foot calluses or cracks, injury, or infection. Symptoms of neuropathy are tingling, numbness, burning, or pain.
Venous stasis ulcers: These are common if you are suffering from varicose veins, leg swelling, or blood clots in the superficial or deep veins of the legs. Unlike arteries, veins return blood to the heart from the legs and the rest of the body. The blood would flow backward if the veins are damaged or blocked. Insufficiency in blood circulation will cause blood to pool resulting in open sores that are slow to heal. These ulcers occur on the inner part of the leg just above the ankle as red and covered in yellow fibrous tissue. In case of an infection, there will be significant green or yellow discharge with irregularly shaped borders and discolored and swollen surrounding skin.

Symptoms of Foot and Leg Ulcers

Foot and leg ulcers sometimes might not be painful. You might have a swollen leg and may feel burning or itching. You might also have a rash, redness, brown discoloration, or dry, scaly skin.

Depending on the type of foot and leg ulcers may have other symptoms such as:

Appear red, yellow, brown, or gray
Drain fluid
Look swollen or bleed when irritated
Leg swelling or cramping
Hardened skin that is purple, dark red, or brown
Itching and tingling
Dry, scaly skin
Fluid-filled blisters
Rash or redness

Diagnosis and Treatment of Foot and Leg Ulcers

Diagnosis is the key to quick treatment. The podiatrist would use various imaging tests to collect information:

Ankle-brachial index test- This test measures blood pressure in the arm and leg using high-frequency sound, and comparing the two together.
Arterial Doppler: This is a type of ultrasound that helps podiatrists check any decrease in blood flow in the arteries and veins.
Venous Doppler: It is also an ultrasound that determines any leakage in your veins or varicose veins.
Computed tomography scans (CT scan): This help podiatrist see the blood vessels in the legs and ulcer. It is determined using detailed cross-sectional images of the vessels.
Magnetic resonance imaging (MRI): This uses radio waves to create a detailed picture of the affected area. It also helps check for infection in the bone and deeper tissue.

Treatment aims to relieve pain, prevent infection and spread of the wound. Few changes to your lifestyle will help foot and leg wounds and ulcers to heal quickly:

Avoid standing for long periods
Increase water intake
Regular feet checks
Podiatry care especially if you have diabetes or smoke
Perform the regular or moderate-intensity exercise
Raise your legs at night
Wear good walking shoes

The treatment regime would depend on the type of ulcer including:

Venous Ulcer Treatment –Compression of the leg to minimize edema or swelling. Wearing compression stockings, multi-layer compression wraps, wrapping an ACE bandage, dressing from the toes or foot to the area below the knee are compression ways.

The dressing is determined by the type of ulcer and the appearance at the base of the ulcer including: