Foot Ulcers

What are the symptoms of foot ulcers and infections?

The main symptoms of foot infections or ulcers include: 

• swelling
• skin dryness
• inflammation
• discoloration
• rash

As the situation deteriorates, the incidence of more severe symptoms increases. Severe symptoms may include callus formation, wound drainage — signifying a much greater risk of infection, scar formation, and a strong odor.

What do foot ulcers look like?

You need to be able to spot a foot ulcer so that you can get the right diagnosis and treatment. While ulcers can be of any shape or form, foot ulcers usually have a wedge shape or crater-like appearance.

Foot ulcers also vary in color; they may be yellow, pink, gray, red, or black. However, a black ulcer signifies that the cells in that area are dead, i.e., necrosis.

Foot ulcers: who is at risk? 

However, like many other diseases, race and medical history determine your risk of foot ulcers. A few of the medical conditions that increase the risk of foot ulcers are:

• circulatory diseases
• obesity
• renal diseases
• high blood glucose levels and poor glycemic control
• use of tobacco and alcohol consumption
• foot deformities like hammertoe

Diabetes is one of the leading causes of foot ulcers, according to the American Diabetes Association. Diabetes-related sores are the most common because diabetes causes poor circulation to the feet, increasing foot complications — including chronic wounds and nerve damage.

What causes foot ulcers

You can develop foot, toe, or ankle ulceration for various reasons. A few foot ulcer risk factors include:

• medical conditions like diabetes
• trauma to the foot
• peripheral arterial disease
• deformities of the toes or toenails (such as bunions)
• exertion of too much pressure on one part of the foot or toe
• bacterial infections like cellulitis
• fungal infections

What are the five types of foot ulcers? 

While ulcers can appear in various body regions and come in different types, foot ulcers generally fall into five common types:

Pressure ulcers 

You may develop pressure ulcers or pressure sores when you remain in the same position for a long time. As the name implies, pressure ulcers result from too much pressure on one part of the foot.

Friction at the sole is one of the primary causes of foot ulcers. Not to mention, constant exposure to pressure leads to callus formation. To reduce pressure before the ulcer worsens, we will focus on offloading — taking weight off the affected area.

Pressure ulcers of the foot can become infected if they are left untreated. If the pressure isn't relieved, the pressure sores on the feet turn into blisters. Foot pressure ulcers are also more likely to occur if you have kidney disease, high blood pressure, or diabetes.

Diabetic ulcers 

Diabetic patients are, unfortunately, at a higher risk of developing leg ulcers. Diabetes affects the blood vessels in the body, increasing the general risk of infection and — specifically — increasing your risk of foot ulcers.

Fundamentally, the increase in blood sugar levels severely damages blood vessels over time. Then, the patient's blood pressure goes down as blood flow to peripheral areas like the limbs worsens.

As a result, infections are more challenging to treat. Diabetic pressure ulcers are also hard to spot because the disease damages nerves. Hence, most patients don't feel pain in diabetic leg ulcers due to neuropathy. If ignored, foot ulcers can lead to gangrene — the death of the tissues in the area.

Patients with diabetic foot ulcers may experience worse side effects due to diabetes complications. Because of the complications from diabetes, amputation may be necessary to prevent the infection from spreading.

Common diabetic risk factors for amputation include peripheral neuropathy, structural foot deformity, ulceration, infection, and peripheral vascular disease. The best way to prevent amputation and preserve your quality of life is to follow up with your healthcare provider and follow their advice for proper blood glucose management and wound care.

Venous leg ulcers 

A venous ulcer is the most prevalent type of leg ulcer. For easy reference, you can also call it an ankle ulcer since a venous ulcer location on the foot is right above the ankle on the inside of the leg.

People suffering from conditions like deep vein thrombosis are at a greater risk of these ulcers. Other health problems like osteoarthritis, leg injuries, varicose veins, and knee and hip replacement surgeries also have greater odds of venous ulcers.

Venous ulcer treatment primarily involves addressing the underlying health problem that is causing the ulcers. Additionally, we will prescribe antibiotics in the case of infection.

Ischemic Ulcers 

Ischemic refers to poor blood flow to an area. Ischemic ulcers mainly occur in the lower limbs. The reduced blood flow to your legs can damage the cells and even cause leg and foot tissue to die.

Ischemic foot ulcers are generally caused by atherosclerosis — the build up of plaque in the arteries preventing adequate blood flow throughout the body.

It is also possible to develop an ischemic diabetic foot because of peripheral arterial disease (PAD) and neuropathy. These factors increase susceptibility to developing ulcers even in mild to moderate ischemia.

Skin Ulcers 

One of the most common types of skin ulcers is leg ulcers. A chronically unhealing wound on the toes, ankles, or legs can progress toward infection.

For diagnosis, doctors suggest a doppler study, which looks at the body's vascular system to find the root cause. Treatment options for skin ulcers include debridement (removal of dead tissue), compression bandages, dressing the wound, or surgery.

Final Thoughts

It’s fundamental to isolate the underlying cause of ulcers. Patients with diabetes should be especially vigilant in checking their wounds and ensuring they heal on time.

If you have foot wounds that keep coming back, exhibit poor ulcer healing, or have other abnormalities, please immediately see a podiatrist.

UFAI, Southern California’s largest foot and ankle wound care specialists

UFAI is nationally recognized for advanced wound care treatment far beyond what a primary care physician can provide. Our podiatrists have decades of combined foot care and ulcer wound healing experience managing the special circumstances surrounding all types of foot problems.

As one of Southern California’s largest and oldest podiatric healthcare practices, our wound care center offers multi-disciplinary medical care and diagnostic testing on-site, offering our patients convenience and peace of mind. For example, we can perform vascular testing at our clinics and have a vascular surgeon on our staff to treat patients with complex vascular diseases.

We are conveniently located throughout Southern California, and the Los Angeles area as our foot doctors are available at locations in or near: Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia, California. We accept over 1000 PPO health insurance plans, including Medicare.

If you want to learn more about how UFAI can help you, we encourage you to schedule a consultation with one of our foot and ankle specialists by calling (877) 736-6001 or making an appointment online.

References

Armstrong DG, Lavery LA, Harkless LB. Treatment-based classification system for assessment and care of diabetic feet. J Am Podiatr Med Assoc. 1996;86:311-6.

Boulton AJ, Malik RA, Arezzo JC, Sosenko JM: Diabetic somatic neuropathies. Diabetes Care 27:1458-1486, 2004.

Faglia E, Clerici G, Caminiti M, Curci V, Somalvico F. Feasibility and effectiveness of internal pedal amputation of phalanx or metatarsal head in diabetic patients with forefoot osteomyelitis. J Foot Ankle Surg 2012;51:593-8.