Ulcers to the feet and legs
In general there are 3 types of ulcerations that can affect the feet and/or legs
- Venous statis ulcers
- Neurotrophic (diabetic)
- Arterial (ischemic ulcers)
Ulcers are typically defined by the appearance of the ulcer, the ulcer location, and the way the borders and surrounding skin of the ulcer look.
Venous Stasis Ulcers
Location on body: Below the knee – primarily found on the inner part of the leg, just above the ankle. Ulcers may affect one or both legs.
Appearance Base: Red in color and may be covered with yellow fibrous tissue. There may be a green or yellow discharge if the ulcer is infected. Fluid drainage can be significant.
Borders: Usually irregularly shaped. The surrounding skin is often discolored and swollen. It may even feel warm or hot. The skin may appear shiny and tight, depending on the amount of edema (swelling).
Who is affected: Venous stasis ulcers are common in patients who have a history of leg swelling, varicose veins, or a history of blood clots in either the superficial or the deep veins of the legs.
Neurotrophic (diabetic) Ulcers
Location on body: Usually located at increased pressure points on the bottom of the feet. However, neurotrophic ulcers related to trauma can occur anywhere on the foot.
Appearance Base: Variable, depending on the patient’s circulation. It may appear pink/red or brown/ black.
Borders: Punched out, while the surrounding skin is often calloused.
Who is affected: Neurotrophic ulcers occur primarily in people with diabetes, although they can affect anyone who has an impaired sensation of the feet.
Arterial (ischemic) Ulcers
Location on body: On the feet – often on the heels, tips of toes, between the toes where the toes rub against one another or anywhere the bones may protrude and rub against bed sheets, socks or shoes. They also occur commonly in the nail bed if the toenail cuts into the skin or if the patient has had recent aggressive toe nail trimming or an ingrown toenail removed.
Appearance Base: Has a yellow, brown, grey or black color and usually does not bleed.
Borders: The borders and surrounding skin usually appear punched out. If irritation or infection are present, there may or may not be swelling and redness around the ulcer base. There may also be redness on the entire foot when the leg is dangled; this redness often turns to a pale white/yellow color when the leg is elevated. Arterial ulcers are typically very painful, especially at night. The patient may instinctively dangle his/her foot over the side of the bed to get pain relief.
Who is affected: Patient’s with poor arterial circulation in the legs and feet.
Foot Care Guidelines and ulcer prevention
The treatment of all ulcers begins with careful skin and foot care. Inspecting your skin and feet is very important, especially for people with diabetes. Detecting and treating foot and skin sores early can help you prevent infection and prevent the sore from getting worse.
Every day, examine your legs as well as the tops and bottoms of your feet and the areas between your toes. Look for any blisters, cuts, cracks, maceration, scratches or other sores. Also check for redness, increased warmth, ingrown toenails, corns and calluses. Use a mirror to view the leg or foot if necessary, or have a family member look at the area for you.
Once or twice a day, apply a quality cream to your legs and the soles and top of your feet to prevent dry skin and cracking. (We have excellent products available in our office) Do not apply lotion between your toes or on areas where there is an open sore or cut. If the skin is extremely dry, use the moisturizing cream more often.
If you have diabetes, it is important to see us regularly. Do not self-treat corns, calluses or other foot problems. Don’t wait to treat a minor foot or skin problem. Call our office and we will see you in a timely manner to address any wounds you have.