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.
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.