Foot Ulcer

Foot Ulcer: What Is It?

A foot ulcer is an open sore on the foot that looks like a red crater in the skin. A foot ulcer can be shallow and only break through the surface skin, or it can be very deep extending through the full thickness of the skin and exposing tendons and bones. Mostly foot ulcers are located on the side or bottom of the foot, or on the top or tip of the toe.foot ulcers on bottom of feet


If treatment is not sought, a foot ulcer can easily become infected. If this occurs, it can develop into an abscess and spread into the skin, underlying fat and even into the bone. This can lead to gangrene, or death of tissue, which requires removal of affected tissue and can lead to amputation of part of the toe, foot or lower leg.


Why Might Someone Get a Foot Ulcer?


Some conditions that may cause a foot ulcer are as follows:


Diabetes – Diabetes is a condition where an individual has a high blood sugar level.  The body either does not produce enough insulin or the cells do not respond correctly to the insulin the body does produce. Foot problems such as foot ulcers are common to diabetics as peripheral neuropathy (problems at the ends of the nerves) and circulatory problems (as outlined below) are often found in diabetics.


Peripheral neuropathy – This condition consists of nerve damage in the feet or lower legs (or hands). Due to the damage, the nerves no longer warn people about pain, so they cannot feel tight-fitting shoes rubbing on the foot or things like a rock in their shoe. This means they can injure their feet without even knowing it.


Circulatory Problems – When there is less blood flowing to the feet the cells are deprived of oxygen. This makes the skin more prone to injury and it also slows down the ability for the foot to heal itself.


Abnormalities in the muscles and bones of the feet – Any alterations to the normal anatomy of the foot can cause a foot ulcer. Bony deformities, Charcot feet, fractures, or arthritis can make finding shoes very difficult and place pressure in specific areas. When people wear shoes that don’t fit properly, a foot ulcer can be a side effect.



If the nerves in the foot are functioning properly, a foot ulcer can be very painful. However, if the nerves are not functioning well, an ulcer can easily go unnoticed. Often with elderly patients their caregiver will be the one who notices a foot ulcer.


How Do We Treat Foot Ulcers?


Your doctor may trim away the diseased tissue around your foot ulcer and remove any callused skin nearby. A dressing will be applied. You may need to visit your doctor frequently to repeat this procedure every few days. You may be given antibiotics if infection is a concern. Researchers have also been looking into ways to speed the healing of a foot ulcer. Certain gels, artificial skin, hyperbaric oxygen, laser, and a form of a medicine called phenytoin have been used to aid in the healing process.


For people that have good blood flow to the foot, an ulcer should clear up within 12 weeks. Deeper ulcers may take a longer period to heal, and sometimes it is difficult for them to heal at all if severe circulation problems are present.


Your doctor, pedorthist, or podiatrist may speak to you about the footwear you should be wearing. Shoes with lots of room and good cushioning that do not put pressure on your feet are what you should look for. Your doctor will often recommend foot orthotics to take pressure off the ulcer site or to prevent a foot ulcer in the future.  If your doctor recommends foot orthotics for an existing ulcer, you should see a pedorthist or podiatrist for assessment and get fit with custom made foot orthotics rather than choosing an over the counter device.


If these conservative treatments do not work, vascular surgery may be necessary to correct blood-flow to the foot.


How to Prevent a Foot Ulcer

Preventative measures can be taken to avoid a foot ulcer. If you are at risk, examine your feet for changes every day, practice good foot hygiene, wear shoes that fit well and good absorbent socks, trim your toenails straight across, and ask your doctor how to care for any corns or calluses you may have.

If you are a person at risk of a foot ulcer, but do not have one, over the counter foot orthotics may help prevent potential issues, especially if you have flat feet, high arches or other biomechanical issues.  Foot orthotics can reduce pressure and unload areas where ulcers are likely to form.  With these foot types, foot orthotics are also an important way to prevent a foot ulcer from returning once it has healed.

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Find a Podiatrist

What Is Podiatry and Who Is a Podiatrist?

Podiatry is a medical specialty dealing with the study, diagnosis and treatment of the disorders and injuries of the foot, ankle and lower leg. Doctors and practitioners who specialize in podiatry are called podiatrists. Podiatrists deal with such issues as plantar fasciitis,  Morton’s Neuroma, flat foot, diabetes foot care, hammertoes, heel pain, plantar warts, infections, arthritis and more.

In the USA, a podiatric physician’s training includes four years of premedical training followed by four years of podiatric studies at medical school. They receive a Doctor of Podiatric Medicine degree, D.P.M.

In Canada, there are some US trained D.P.M’s as well, but many practitioners who are called podiatrists are actually chiropodists, who have a three or four year program in foot care, but are not physicians and do not do surgery or deal with strong prescription medication.  Though many of them have excellent training for the services they provide, some in the Canadian medical community object to their use of “Dr.” in front of their name because the nature of their training is not the same as that of actual physicians.


Where Do I Look to Find a Podiatrist?

If you are experiencing foot pain and need to find a podiatrist there are several places to look. First of all, speak with your primary care physician. They may have a podiatrist they recommend that they can refer you to. Ask family, friends or co-workers who may have seen one in the past. Check out the yellow pages or ask at your local hospital. The internet can also be a great resource to find a podiatrist. Most provinces or states have a website that outlines the podiatrists working in each city.


To find a podiatrist in the United States, check out the following:

American Podiatric Medical Association (APMA) –

American College of Foot and Ankle Surgeons (ACFAS) –


Some sites to find a podiatrist in Canada:

Canadian Podiatric Medical Association –

New Brunswick Podiatry Association –

Alberta Podiatry Association –

British Columbia Association of Podiatrists –

Ontario Podiatric Medical Association –

Quebec –
When searching to find a podiatrist you may also want to check with your insurance company. Not only should they have a list of podiatrists, but you may only be covered with certain podiatrists, or by individuals with a specific kind of podiatry training.


I Found a Podiatrist, Now What?

After your search to find a podiatrist has been successful and you make an appointment you are on your way. Make sure you are comfortable with your podiatrist and don’t be afraid to ask questions about their experience or your condition. If you find a good podiatrist, he or she will take time to explain your diagnosis, listen to your concerns and treat you with respect….and hopefully he or she will also alleviate your foot problem so you can continue to do the things you like to do.


Podiatrists and Foot Orthotics

Podiatrists are one of the primary caregivers who offer custom foot orthotics as a treatment option. They may refer their patients to a pedorthist for evaluation, or evaluate the patient themselves and send the evaluation to a pedorthist to manufacture the foot orthotics for them.

The other option would be to find an appropriate over the counter foot orthotic to serve their patients. This is a much less expensive option and can be just as effective as custom treatment in many cases…though there are some feet that cannot be helped without a custom product. If using an over the counter device, find one that is customized for your specific condition or area of pain.


What are Foot Doctors

Foot Doctors: What Do They Deal With?

Foot doctors specialize in the study, diagnosis and treatment of the foot, ankle and lower leg. Foot doctors are also known as podiatrists, chiropodists or foot specialists.

Foot Doctors: Why Would I Need One?

Some disorders foot doctors deal with include: plantar fasciitis, metatarsalgia, flat foot, Achilles tendonitis, Morton’s neuroma, heel pain, heel spurs, hammertoe, foot deformities, ingrown toe nails, plantar warts, neurological and vascular conditions, and more. If you are experiencing pain in your arch, heel, knees, toes or even your back, it may be a problem with your feet.

Foot doctors will assess and treat your foot condition. Oftentimes your pain may be reduced by something as simple as wearing a custom made or over the counter foot orthotic in your shoe.

Foot Doctors: Tips on Choosing Them

When choosing foot doctors, you should ensure you are comfortable with your choice. A lot of foot doctors have specialties, so you may want to consider this when making a decision on foot care. It is estimated we take an average of 5000-12000 steps each day, so we should take extra care when dealing with our feet.

Foot Doctors: Where Do You Find One?

When looking for foot doctors, ask someone you trust who may have had experience with one. Speak with family and friends for a recommendation. Ask your doctor who’s skills he or she feels comfortable with.

The internet is a great place to find information on foot doctors in your area.

Research the foot doctors in your area before you schedule an appointment. Make sure they are qualified, insured, and have no history of dishonesty or over billing. A bit of due diligence will make your experience with your foot doctor a much less stressful one.

Plantar Fasciitis Treatment

Plantar Fasciitis Treatment: What is Plantar Fasciitis?

Plantar Fasciitis is a condition in which the plantar fascia becomes inflamed and irritated. The plantar fascia is a relatively inflexible, thick fibrous band of tissue that extends from the heel to the ball of the foot and is a supportive platform for the arch. Movements such as walking or running stretch the plantar fascia and can cause small tears, which lead to inflammation and pain. When you walk, your weight is distributed across your feet, but any imbalances in alignment and the mechanics of your foot can eventually cause pain. High arches, flat feet, or even the surface you are walking on can cause poor mechanics.

Which Plantar Fasciitis Treatment Should I Consider?pain in heel from plantar fasciitis

The most effective plantar fasciitis treatment for the most common causes of plantar fasciitis  are arch supports or orthotic insoles that you insert into your shoes.  The issue is usually associated with abnormal foot mechanics alignment such as high arches, overpronation, or flat feet.  This means that the best plantar fasciitis treatment option will control or accommodate mechanics and alignment, which also means arch supports (orthotic insoles).

Another potential plantar fasciitis treatment would  be a night splint. Night splints work to provide a gentle stretch to your plantar fascia while you sleep. This controlled stretch keeps the plantar fascia from tightening up overnight and is a common way to alleviate the early morning pain individuals with plantar fasciitis often experience.

Footwear is also a big part of plantar fasciitis treatment. Shoes that do not fit properly or that require forcing your feet into a cramped space can be the cause of plantar fasciitis and other foot problems. Choose your shoes wisely.

If you have ongoing problems with heel and arch pain, talk to your doctor about plantar fasciitis and he or she may refer you to a pedorthist or podiatrist.

Temporary Plantar Fasciitis Treatments

There are a few things you can do yourself to provide temporary plantar fasciitis treatment. First of all, when your foot is painful, you can ice the affected area to numb the nerve endings and take the inflammation down. If you are carrying extra weight, losing it can be considered a plantar fasciitis treatment because it decreases pressure on your feet.

Massaging the arch area of the foot and completing stretching exercises for the plantar fascia and the calf muscles can also be used as a treatment for plantar fasciitis. Avoiding activities such as walking or running helps the healing process, but can often be a difficult treatment if your work requires you to be on your feet. If you must walk or complete specific activities a good plantar fasciitis taping technique can be used to provide support to the plantar fascia. You can also see a physical therapist or physiotherapist for plantar fasciitis taping and exercise techniques and modalities to relieve pain and inflammation.

More Invasive Plantar Fasciitis Treatment

Corticosteroid injections are occasionally used as a treatment for plantar fasciitis, but, this is usually combined with foot orthotics designed to correct biomechanical deficiencies if you do not want the problem to return.

A “last resort” plantar fasciitis treatment is surgery. Plantar fasciitis surgery is not a common treatment as only about 5% of people with the condition require it, provided no other plantar fasciitis treatment has been successful. The surgery involves fully or partially cutting, or detaching the plantar fascia from the heel bone. This decreases the tension of the fascia, taking away the pain. Like with the use of steroid injections, the underlying alignment problems must also be addressed.

Where to Get Plantar Fasciitis Treatment

If plantar fasciitis is your problem, your doctor will determine what action must be taken for you to receive the appropriate plantar fasciitis treatment. They will often send you to a pedorthist or podiatrist for foot orthotic insoles.  These are the best treatment for plantar fasciitis in the majority of cases and should be considered along with any other forms of treatment to correct biomechanical issues and prevent the return of plantar fasciitis.

Orthopedic Shoes Fitting & Stability Guide

Orthopedic Shoes Stability and Fitting 101:

Fitting the appropriate orthopedic shoes ( is just as important as finding the best arch supports (foot orthotics). man trying on orthopedic shoes Without the proper shoes to place them in, foot orthotic insoles just don’t work.  Some conditions can be improved, and even eliminated just by changing your shoes.

Whether you wear foot orthotic insoles or not, a stable, properly fit orthopedic shoe is essential for the health of your feet.

Orthopedic Shoe Evaluation

The ability to evaluate shoe fit and stability is essential for anyone who wears shoes if you want to maintain healthy and happy feet. This checklist should give you the ability to evaluate and fit shoes properly.

One of the biggest misconceptions when fitting shoes is that you will fit the same size shoe no matter what brand you are buying.  This is not the case.  Shoe sizes are not well standardized and a size 8 in one brand may be exactly the same size as a 9 in another brand…or even with different models in the same brand.  Try them on both feet, and fit to the larger foot.  It’s better to have a little bit too much room than not enough, and easier for a shoe fitting professional to accommodate with additions in the shoe that fits slightly larger.

Follow through the information below and you will learn how to assess for shoe fit and stability like a pro.

Shoe Stability

Written explanations below the video…the video shows a shoe with enough stability for most foot types.

1) Evaluate Midfoot stability (Video above: Bend Test)

  • Hold the shoe in both hands, one under the toes and one at the heel.
  • Bring your hands together like you are trying to touch palm to palm.
  • The shoe should bend at the ball of the foot where your foot normally bends. If it rolls up like a ball it is not stable enough. If it bends anywhere other than at the ball of foot area at the widest part of the forefoot, the bend is in the wrong place.

2) Evaluate Torsional Stability (Video above: Twist Test):

  •  Hold underneath the toe area of the shoe in one hand and the heel in the other.
  •  Twist your hands in opposite directions.
  •  This should be difficult and require some force to get movement.  If you can twist it like a wet rag, it is not sufficiently stable.


3) Evaluate the Heel Counter (Video above: Heel Counter):

  • Set the shoe in the palm of one hand.
  • Take the other hand and place your thumb in the middle of the heel counter.   (The back part of the shoe that covers the back of  your heel.)
  • Push the heel counter and see if it collapses under the pressure of your thumb.  If it does, the heel counter is too weak to offer appropriate support.

Orthopedic Shoes Fitting

4) Evaluate Foot Shape

  • Try on the shoes, lace them up, and stand with weight evenly on both feet.
  • Check for areas of pressure around the feet.  Make sure you check the area at the base of the little toe and the base of the big toe on the sides of the feet (fifth and first metatarsal heads) as these are two of the most common problem areas associated with a foot shape and shoe shape mismatch.

To get more detailed you can also:

  • Stand on a piece of paper with weight evenly on both feet and have someone trace them with a pen (do both feet).
  • Compare your tracing to the shape of the orthopedic shoe.  A great way to compare is to pull out the factory insole and line it up with the foot tracing.  This allows you to see areas where the shape does not match.  Check both feet.

5) Evaluate Toe Space (Length)

  • Make sure the orthopedic shoes are on and laced properly.
  • Stand up with weight evenly on both feet.
  • Take your thumb and turn it sideways at the end of the shoe and feel for the toes.  There should be about 1/4 to 1/2 inches of space between the end of the toes and the end of the shoe.

6) Evaluate Forefoot  Space

  • Make sure the shoes are on and laced properly.
  • Stand up with your weight evenly on both feet.
  • Take your thumb and index finger and pinch the shoe material at the widest part of the forefoot, which would be by the ball of the foot.
  • You should be able to pinch about 1/4 inches (5mm to 7mm) of the material in this area of the shoe. it is difficult to actually get the material pinched between your fingers in most cases, so this can be equated to a bit of the material rolling under your fingers.  If it’s stretched too tight to get any movement, it’s too tight, and if you can pinch more than 1/4 inch, it’s too loose.

7) Evaluate Throat  Space

  • Put the shoes on, but do not lace up.
  • Stand up with your weight evenly on both feet.
  • Slide your fingers under the tongue and to the space at the base of the laces.  You should be able to fit one to two fingers in the space.  If not, it’s too shallow.  If more than 2 fingers, there is too much room there.

8) Evaluate Heel  Space

The best test for heel space is to walk with the shoe on and see if it rubs or irritates anywhere, or if the orthopedic shoe slips up and down on the heel.  Make sure the shoes are on and laced properly.  The shoe should fit snugly around the heel. If it’s pinching, it’s too tight.  If it does not fit snugly and there is excessive space between the heel and the inside of the shoe, it’s too loose and will rub and slide.

9) Evaluate Ankle  Space

Similar to heel space, the best test  is to walk with the shoe on and see if it rubs or irritates at the heel cord (Achilles tendon) or ankle bones (malleoli), or if the heel slips up and down (or out of the shoe) when you walk and move.

10) Evaluate Location Where the Orthopedic Shoe Bends

  • Make sure the shoes are on and laced properly.
  • Take a step forward with your right foot, leaving the toes of your left foot on the ground, but lifting your left heel.
  • Look at where the shoe bends and see if the ball of your foot bends in the same location.

Orthopedic Shoe Fitting Tips if You Wear Foot Orthotics

  • Should have removable insoles and enough depth and volume to fit both the foot orthotic and the foot without too much pressure.
  • Do all fitting evaluations with both the feet and the orthotics in the shoe.
  • Laces are better because they are more adjustable and can be tightened for stability or loosened if more room is required.
  • Avoid pointed toed shoes…stick with rounded or square toes.
  • Keep heel height under two inches.
  • Avoid motion control shoes if you are using foot orthotics, unless recommended by your foot specialist.


Foot Treatment

Who Can Help?foot treatment from a podiatrist

90% of people will have foot pain at some point in their lives. This tells us that foot treatment is a very important field. Podiatrists or chiropodist are the doctors who specialize in this area. You can search for a podiatrist in your area or look for a foot clinic that may be able to help you if you are experiencing foot pain. Foot treatment will vary depending upon what is wrong with your feet.

Common Foot Treatment Solutions

Foot treatment that is common to most problems or injuries includes rest and choice of footwear. The footwear you choose is an extremely important decision for your foot health. Make sure your feet are not squished into an area they don’t fit in! Choose shoes with good support and choose the correct type of shoe for the task at hand. For example, if you are planning on jogging, choose a running shoe; if you are playing an indoor sport such as volleyball or badminton, choose a court shoe…if you don’t use appropriate shoes, you are not treating your feet appropriately. Temporary relief from foot problems that involve inflammation may include applying ice to the affected area and anti-inflammatory drugs.


What Foot Treatment Do I Need For My Specific Problem?

  • Foot treatment will be different for each specific problem. Following are some examples for specific conditions:
  • Arch Supports or Foot Orthotics are often the answer for individuals with flat feet, high arches, Morton’s Neuroma, metatarsalgia, and many other conditions. Foot orthotics help distribute your weight more evenly and improve biomechanical deficiencies in your gait.
  • Gel metatarsal cushions or pads may be a foot treatment for some ball of foot issues as they can provide some extra comfort. They can be built into foot orthotics.
  • Heel cups or heel cradles are often suggested as a foot treatment for heel spurs or plantar fasciitis and also can be built into foot orthotics.
  • Night splints have proven to be an effective foot treatment for plantar fasciitis, Achilles tendonitis or heel pain.
  • Shoe lifts are sometimes prescribed to adjust leg length discrepancies that can be a cause of foot pain.
  • Your doctor may give you a routine of stretching exercises as a foot treatment. These may improve strength and mobility therefore decreasing your pain or your chances of further injury.
  • Foot treatment that is used for Athlete’s foot or other funguses may include antifungal medications.
  • Foot treatment for foot ulcers may include your doctor trimming the diseased tissue around your ulcer and applying a dressing on a regular basis. Antibiotics may be given to treat infected feet as well.
  • A corticosteroid injection is a possible foot treatment for ball of foot or metatarsal pain.
  • An application of intense cold, known as cryotherapy, is a foot treatment offered for some neuromas.
  • Extracorporeal shock wave therapy is a foot treatment used to help the body’s tissue repair process for heel spurs.
  • As a last resort, surgery may be a foot treatment if no conservative methods have worked. Some surgeries performed include bunionectomies, tendon transfers, arthoplasty or arthrodesis.
  • These are just a few examples of the many foot treatment available for a variety of foot problems. May your feet stay healthy enough that you never need any of them!