Foot Ulcers


  When to see a Podiatrist

Call your podiatrist promptly if you see an area of:

  • Redness
  • Swelling
  • Bleeding
  • Blisters

A foot ulcer is an open sore on the foot. Ulcers can be shallow, red craters that involve  only the surface skin. They can also can be very deep. A deep foot ulcer may be a crater that extends through the full thickness of the skin. It may involve tendons, bones and other deep structures. If an infection occurs in an ulcer and is not treated right away, it can develop into:

· An abscess (a pocket of pus)

· A spreading infection of the skin and underlying fat (cellulitis)

· A bone infection (osteomyelitis)

· Gangrene is an area of dead, darkened body tissue caused by poor blood flow.

Individuals with chronic kidney diseases (CKD) are at high risk of foot ulceration and major lower extremity amputation. The risk status of any patient on dialysis should automatically be considered as being high, even in the absence of any active foot problems.  A referral to a podiatrist for expert advice and treatment should occur if an active foot problem is discovered.

Symptoms

One of the first signs of a foot ulcer is drainage from your foot that might stain your socks or leak out in your shoe. Unusual swelling, irritation, redness, and odours from one or both feet are also common, early symptoms of a foot ulcer.

The most visible sign of a serious foot ulcer is black tissue (called eschar) surrounding the ulcer. This forms because of an absence of healthy blood flow to the area around the ulcer. Partial or complete gangrene, which refers to tissue death due to infections, can appear around the ulcer. In this case, odorous discharge, pain and numbness can occur.

Signs of foot ulcers are not always obvious. Sometimes, you won’t even show symptoms of ulcers until the ulcer has become infected. Talk to your doctor or a podiatrist if you begin to see any skin discoloration, especially tissue that has turned black, or feel if you any pain around an area that appears callused or irritated.

Your doctor may refer you to a podiatrist for treatment, or you can go directly to a podiatrist yourself.

    Treatment

    If you have good circulation in your foot, your podiatrist may treat your foot ulcer with a procedure called debridement. This consists of trimming away diseased tissue and also removing any nearby callused skin.

    The podiatrist will then apply a dressing. He or she may also prescribe specialized footwear to relieve pressure on the ulcerated area. This specialized footwear may be a cast. Or it may be a loosely fitting postoperative walking shoe or sandal that can be worn over a bandage.

    Your podiatrist will need to see you frequently to examine and debride the area. A nurse may also need to visit you to change the dressing every several days. Proper care of a foot ulcer can require multiple visits over weeks or months. The visits will last for as long as it takes for your ulcer to heal completely. If there is a possibility of infection, antibiotics may be prescribed.

    Once the ulcer has healed, your podiatrist may prescribe roomy, well-cushioned footwear. This footwear should not put pressure on vulnerable areas of your feet. This will help to prevent ulcers in the future.

    Foot ulcers that do not respond to more conservative therapy may require surgery. In certain situations, without leg surgery the ulcer may not heal properly.

    People with poor circulation may need a procedure or surgery to open one or more blocked arteries in the legs. When possible,  the blockage may be opened with angioplasty.   This is usually done by threading a deflated balloon with a wire mesh cover (called a stent) into the blocked area. The balloon is inflated. This opens the artery. The stent stays in place to hold the artery open. For more significant blood flow problems, surgery is usually needed to re-route blood flow through the leg using a bypass artery.

    Causes 

    Foot ulcers are most commonly caused by:

    • poor circulation
    • high blood sugar (hyperglycemia)
    • nerve damage
    • irritated or wounded feet

    Prevention

    Individuals with chronic kidney disease can take steps to help prevent foot ulcers. They should examine their feet routinely and follow good foot hygiene practices.

    The following strategies may help prevent foot ulcers:

    • Examine every part of your feet every day to check for rubbed areas, cracks or calluses. If necessary, use a mirror to check the heel and sole. 
    • 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 shoes that fit well and wear 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 with a nail clipper or emery board.
    • If you have corns or calluses, ask a podiatrist about how to care for them. Your podiatrist may determine that these problems are best treated in his or her office, rather than at home.


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