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. However, they can also can be very deep. A deep foot ulcer may extend through all the layers 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 (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 the foot that might stain the socks. Other early symptoms include swelling, irritation, redness, and odours from the feet.

The most visible sign of a serious foot ulcer is black tissue (called eschar) surrounding the ulcer. This is formed when there is an absence of healthy blood flow to the affected area of the foot. Partial or complete gangrene (tissue death due to infections) can also appear around the ulcer. In this case, odorous discharge, pain and numbness are common.

Signs of foot ulcers are not always obvious. Some ulcers might not even show any symptoms until it is 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. You do net need a referral to see a podiatrist.

    Treatment

    If patients with proper circulation in foot foot, an ulcer may be treated with a procedure called debridement- trimming away diseased tissue and 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, loosely fitting postoperative walking shoe or sandal that can be worn over a bandage.

    After the procedure, the foot must be examined frequently to debride the area. The dressing may also need to be changed every couple of days. Proper care of a foot ulcer can require multiple visits over weeks or even months. Medical attention of the foot is required till the ulcer has healed. Antibiotics may be prescribed to prevent the risk of infection.

    Once the ulcer has healed, your podiatrist may prescribe roomy, well-cushioned footwear. This footwear will prevent pressure on vulnerable areas of the feet and help prevent future ulcers.

    In certain situations, without leg surgery the ulcer may not heal properly. In cases where ulcers do not respond to more conservative therapy, surgery may be needed.

    People with poor circulation may need a procedure or surgery to open one or more blocked arteries in the legs. This may be done with angioplasty which involves threading a deflated balloon with a wire mesh cover (called a stent) into the blocked area. The balloon is then inflated -opening 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 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 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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