Ulceration – A foot ulcer is where an area of skin has broken down and you can see the underlying tissue. They vary in size and depth and may involve tendons, bones and other deep structures. It can be difficult to heal a foot ulcer so recognising risk factors and working towards prevention is paramount.
A foot ulcer looks like a red crater in the skin and may have white edges around the outer of the wound. Most foot ulcers are located on the side or bottom of the foot or on the top or tip of a toe (where there may be an increase in pressure, in most cases from footwear). This round crater can be surrounded by a border of thickened, callused skin. This border may develop over time. In very severe ulcers, the red crater may be deep enough to expose tendons or bones.
If the nerves in the foot are functioning normally, then the ulcer will be painful. If not, then a person with a foot ulcer may not know it is there.
Foot ulcers are especially common in people who have one or more of the following health problems:
> Diabetes (type 1 or 2)
> Circulatory problems – Any illness that decreases circulation to the feet can cause foot ulcers because less blood reaches the feet, which deprives cells of oxygen. This makes the skin more vulnerable to injury and it slows the foot’s ability to heal.
> Abnormalities of the foot -Any condition that distorts the normal anatomy of the foot can lead to foot ulcers.
> Raynaud’s phenomenon – This condition causes sudden episodes of decreased blood flow to the fingers and toes.
It is rare for a foot ulcer to be unrelated to the above risk factors and illnesses. In most cases a patient with the above conditions will receive regular podiatry treatments from local NHS services and an ulceration would increase the patient’s risk factors. Due to this it is common that the ulceration treatment would be dealt with at NHS level for free. This would consider:
> depth, size, smell of wound
> signs of infection
>biomechanical abnormalities that may be contributing to increased pressure
> advice on footwear
> advice on lifestyle factors that may cause the ulceration and also delay the healing process such as smoking, obesity and alcohol consumption
At David Brown Podiatry we can treat foot ulcerations in the same way as NHS but the expense would have to be met by the patient. We can discuss the level of care needed at your appointment and tailor a treatment plan to suit your specific needs.
A foot ulcer in a person who has none of the above health problems may need to be checked for skin cancer, especially squamous cell carcinoma. This cancer occasionally looks like a foot ulcer. In this case an appointment to your GP would be recommended.
If you have good circulation in your foot, your podiatrist (either NHS or David Brown Podiatry) may treat your foot ulcer with a procedure called debridement (or shaving away dead skin). This will allow the healing process to be effective. Sterile (and sometimes antibacterial) dressings will be applied to reduce the chance of infection and to redistribute pressure if needed. It is essential that the dressing stays on the wound and is kept dry until changed by your podiatrist. Advice on footwear will be given in order to ensure that the ulceration is protected effectively. Depending on the stage of the ulceration, you may need regular appointments (some serious cases twice weekly) to monitor the wound and change dressings to ensure the wound is in the best environment to heal.
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.
Among people with diabetes, most severe foot infections that ultimately require some part of the toe, foot or lower leg to be amputated start as a foot ulcer.
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People who are at risk of foot ulcers, such as those with diabetes, can take steps to help prevent foot ulcers. At David Brown Podiatry we have a pressure plate which can highlight any area that may be under increased pressure and further risk of ulceration. The following strategies may help prevent foot ulcers:
> Examine every part of your feet every day to check for areas of excessive dryness or changes to the quality of skin (callus/corns). If necessary, use a mirror to check the heel and sole. If your vision is not good, ask somebody to check for you.
> Wash your feet every day. Dry thoroughly, especially between the toes to avoid athlete’s foot. Apply moisturising cream to dry areas, but not between the toes, again to avoid athlete’s foot.
> Wear shoes that fit well and soft, absorbent socks. Always check your shoes before putting them on to ensure there are no foreign objects. Change your socks regularly if they become wet or excessively sweaty.
> Take care when cutting your toe nails and always file the corners.