Foot Ulcers and Wounds

Definition of an ulcer: an open sore on an external or internal surface of the body, caused by a break in the skin or mucous membrane that fails to heal

Definition of wound care: steps taken to ensure that a wound such as a foot ulcer heals correctly

What is an ulcer?

An ulcer is an open wound in the skin that appears as an open crater and exposes the deeper tissue. Ulcers are wounds that generally will not heal or keep reoccurring.

What does an ulcer look like?

• Open sore exposing deeper tissue
• Skin around sore may be red, swollen and painful
• Fluid may ooze from the ulcer (blood or pus)
• May have a swollen leg with burning or itching sensations

Common Ulcers of the Leg and Foot

Venous ulcers

Arterial ulcers (ischemic ulcers

Neuropathic ulcers

What are venous ulcers?

Venous ulcers are commonly seen above the calf or on the lower ankle. Venous ulcers are most common in patients who have a history of swollen legs, varicose veins or a history of blood clots.

Characteristics of a venous ulcer are:

• Shallow sore
• Irregular shape
• Usually appear on the lower leg and ankle
• Associated with contact dermatitis
• May/may not be painful

Risk factors for a venous ulcer are:

• Deep vein thrombosis (blood clot)
• Congestive heart failure
• Varicose veins
• Obesity
• Long periods of sitting or bed rest
• Pregnancy

What are arterial ulcers?

Arterial ulcers are commonly seen on the outside (lateral) part of the foot, ankle or leg. Arterial ulcers are most common in patients with very poor circulation and blood flow to the leg. When pressure is placed on the skin, due to foot structure or even ill-fitting footwear, the skin is damaged but unable to repair itself due to poor blood flow to the tissue, which can lead to an ulcer.

Characteristics of an arterial ulcer are:

• deep sore
• punched-out appearance
• smooth wound edges
• found mainly on the outside (lateral) of the leg or foot
• skin is pale, shiny, thin and taut
• minimal to no drainage from the wound
• very tender and painful

Risks for an arterial ulcer are:

• poor circulation
• ill-fitting footwear
• renal disease
• increased aged
• certain disease such as diabetes or peripheral arterial disease

What are neuropathic ulcers?

Neuropathic ulcers are associated with patients who have lost their sensation to pain. Patients will typically exert a lot of pressure at certain spots under their feet when they walk creating a build-up of callus. As time progresses, the pressure becomes so high that the callused area eventually breaks down and an ulcer is formed except the patient will hardly notice any pain.

Characteristics of a neuropathic ulcer are:

• painless
• surround by callus (thick, dead skin)
• located typically around the bottom of the foot or the tips of toes

Risks for a neuropathic ulcer are:

• history of foot ulcers
• loss of sensation in the feet (neuropathy)
• poor circulation
• swollen feet
• ill-fitting footwear

How do you treat leg ulcers?

Since every patient is unique and every ulcer is different, each patient’s treatment plan will be based on the type of ulcer, patient’s general health and ability to care for the wound.

The goal at Mississauga Foot Clinic is to ensure the necessary steps are taken so foot ulcers heal correctly. Treatments will focus on relief of pain, speed up recovery and heal the wound.

General treatment options for ulcers may include:

• Antibiotics (if an infection is present)
• Medications to prevent a blood clot (Anti-platelet or anti-clotting)
• Wound dressings
  • Hydrogels/hydrocolloids
  • Alginate dressings
  • Collagen wound dressings
  • Autolytic agents (debriding agents)
  • Antimicrobial dressings
  • Compression stockings
  • Topical wound care therapies
  • Custom-made orthotics or shoes to offload areas of pressure
  • Padding to offload areas of pressure

How can ulcers be prevented?

• By decreasing the major risks of ulcers you can help prevent ulcers from developing or getting worse
• Quit smoking
• Control your cholesterol levels
• Manage your blood pressure
• Manage your diabetes and control your blood sugar levels
• Discuss possible drug therapies with your family physician to prevent blood clots
• Exercise (seek medical advice from your family physician before starting)
• See your family physician at least once a year for a full physical examination
• See your foot specialist to get a comprehensive foot exam performed