Ulcers are open sores that fail to heal or keep returning despite treatment. Sometimes ulcers are accompanied by inflammation of the skin, rashes, redness, discoloration or dry, scaly skin. Ulcers tend to form on the legs where they produce an itching or burning sensation.
Ulcers usually appear when there is poor blood flow in the legs. People with diabetes are especially at risk of developing foot ulcers, due to either poor blood flow or losing sensation in the feet, which can result in pressure sores. For these patients, proper foot care is essential.
Other causes of ulcers include:
- Traumatic injury
- Vascular disease (stroke, heart attack, angina)
The three most common types of leg and foot ulcers are:
- Arterial ulcers
- Neurotrophic ulcers (diabetic ulcers)
- Venous statis ulcers
Arterial ulcers occur in patients who have poor circulation in their legs, resulting from any of the following conditions:
- Chronic kidney failure
- Hypertension (treated or untreated)
- History of smoking
- Inflammatory diseases
- Malignancy (tumor or cancerous mass)
Arterial ulcers often appear on the heels, tips of the toes, between the toes, or anywhere bones protrude and rub against socks, shoes or bed sheets. Arterial ulcers can also occur on the nail bed if the toenail cuts the skin, or if the patient has used nail clippers too aggressively. These ulcers appear yellow, brown, black or gray, with borders and surrounding skin that look punched out. Arterial ulcers typically do not bleed or weep.
Neurotrophic, or diabetic, ulcers are common in patients with diabetes, though they can occur in anyone who has lost sensation in the feet. These ulcers result from either trauma or increased pressure points at the bottom of the feet. Depending on the patient's circulation, the ulcers can appear pinkish red or brownish black. The ulcer's borders are punched out, and the surrounding skin is frequently calloused.
Venous statis ulcers are common in patients with varicose veins and/or a history of leg swelling or blood clots in the superficial or deep veins of the legs. These ulcers are usually found on the inner part of the leg just above the ankle. The ulcer is typically red and may be covered in yellow fibrous tissue. If there is an infection, there will be significant green or yellow discharge. The borders of the ulcer are irregularly shaped and the surrounding skin is often discolored and swollen.
In extreme cases, non-healing ulcers can result in a limb amputation. The Temple Limb Salvage Center specializes in treating patients who are at risk for an amputation. Using preventive medicine, medications, novel therapies and limb-sparing surgical techniques, they aim to preserve their patients' health while providing viable alternatives to amputation.