FOOT ULCER
Foot ulcers are open sores on the foot. Hot spots are areas of increased pressure that are usually red and warm before the ulcer develops. Some foot ulcers are superficial, producing a shallow red sore that involves only the surface skin. Other foot ulcers are very deep, producing a sore that extends through the full thickness of the skin, sometimes involving tendons, bones and other deep structures. In vulnerable individuals, especially those with diabetes or poor circulation, even a small foot ulcer can become infected if it is not treated quickly. If this local infection is allowed to progress, it can lead to an amputation. Among persons with diabetes, a seemingly simple foot ulcer is the initial problem in approximately 85 percent of severe foot infections that ultimately require amputation of some part of the lower limb.
Foot ulcers are especially common in persons who have one or more of the following health problems:
 | Peripheral neuropathy — In peripheral neuropathy (nerve damage in
the extremities), the nerves that normally detect sensations in the feet can
no longer warn about pain or discomfort. When this happens, even tight-fitting
shoes can trigger a foot ulcer by simply rubbing on a portion of the foot that
has become numb to the sensation. People with peripheral neuropathy may not
be able to "feel" it when they've stepped on something sharp or when they have
an irritating pebble in their shoe. They can significantly injure their feet
and never know it, unless they routinely examine their feet. Unfortunately, many elderly individuals and diabetics with vision
problems cannot see their feet well enough to perform even this simple foot
examination. This is one of the reasons why elderly individuals with
peripheral neuropathy develop foot ulcers more than nine times as often as
those with normal foot sensation. |
| Circulatory problems — Any illness that decreases circulation to
the feet can cause foot ulcers by decreasing the foot's blood supply, which
deprives cells of oxygen, making the skin more vulnerable to injury and
slowing the foot's ability to heal. People are at especially high risk of
foot ulcers if the circulation in their leg arteries is reduced because of atherosclerosis, a disease that is triggered by fatty deposits of cholesterol
within the walls of arteries. |
| Abnormalities in the bones or muscles of the feet — Any condition that distorts the normal anatomy of the foot can lead to foot ulcers, especially if the foot is forced into shoes that cannot accommodate the foot's altered shape. Diabetics are at higher risk of foot abnormalities that can lead to foot ulcers. |
More than any other group, persons with diabetes have a particularly high risk of developing foot ulcers. This is because the long-term complications of poorly-controlled diabetes often include the triple risk factors of neuropathy, circulatory problems and a gradual development of structural abnormalities in the feet. Among the estimated 16 million diabetics living in the United States, approximately 15 percent will eventually develop an ulcer involving either the foot or ankle. Without prompt and proper treatment, this ulcer may become so severe that it requires hospital treatment or even amputation.
Symptoms
A foot ulcer looks like a red crater in the skin, usually located on the sole of the foot or between the toes. In many cases, this crater is surrounded by a well-defined border of thickened, callused skin, especially if it has been present on the foot for a fairly long time. In very severe ulcers, the red crater may be very deep, exposing foot tendons or bones.
If the nerves to the foot are functioning normally, then the ulcer will be painful. If not, then the patient may not know that the ulcer is there, particularly if the ulcer is located on a less-obvious portion of the foot. In debilitated or elderly patients, a relative or caregiver may first notice the problem when the ulcer becomes infected, drains pus and develops a foul odor.
Diagnosis
In most cases, your doctor can tell that you have a foot ulcer by simply looking at your foot, but this is only the beginning of the diagnostic process. Your doctor will assess the control of your blood sugar and will ask about your routine foot-care practices and the type of shoes that you usually wear. This is because poor foot hygiene and poorly fitting shoes can increase the risk of foot ulcers in susceptible individuals. Evaluation of the ulcer includes determining:
| How deep the ulcer is |
| Whether there is an infection |
| Whether that infection has entered the bone |
| Whether you have any underlying foot abnormalities, circulatory problems or neuropathy that will either interfere with healing or increase the risk that the ulcer will recur |
The duration of a foot ulcer depends on the depth of the ulcer, the adequacy of blood circulation to supply oxygen and nutrients, and whether there is any secondary infection. In persons who have good circulation and good medical care, a superficial ulcer can sometimes heal in as little as five to six weeks. Deeper ulcers may take 12 to 20 weeks and sometimes require surgery.
Prevention
Persons who are at risk of foot ulcers, especially those with diabetes, can probably prevent about 50 percent of foot ulcers by routinely examining their feet and following good foot hygiene practices. The following strategies may help:
| Examine every part of your feet every day . If necessary,
use a mirror to check the heel and sole. If your vision is not good, ask a
relative or caregiver to examine your foot for you. |
| Practice good foot hygiene. Wash your feet every day using mild soap and
warm water. Dry thoroughly, especially between the toes. Apply moisturizing
lotion to dry areas, but not between the toes. |
| Wear well-fitting shoes and soft, absorbent socks. Always check your shoes
for foreign objects and rough areas before you put them on. Change your socks
immediately if they become wet or sweaty. |
| Trim your toenails straight across, do not dig into the
corners. |
| If you have corns or calluses, ask you podiatrist to
treat them. |
Prognosis
In patients with superficial foot ulcers, the prognosis for healing is good if the foot's circulation is adequate. By using the best wound-care methods available, most ulcers should heal within 12 weeks. Unfortunately, about 30 percent of healed ulcers recur, particularly in patients who do not wear specialized footwear prescribed by their doctor.
If you are a diabetic or if you suffer from poor circulation or peripheral neuropathy, examine your feet every day. If you see an area of redness, swelling, bleeding, blisters or any other abnormality, call today for an appointment .