Ulcers are wounds or open sores that will not heal or keep returning. Ulcers may or may not be painful. The patient generally has a swollen leg and may feel burning or itching. There may also be a rash, redness, brown discoloration or dry, scaly skin. The three most common types of leg and foot ulcers include (What causes leg and foot ulcers?):
- Venous stasis ulcers
- Neurotrophic (diabetic)
- Arterial (ischemic ulcers)
Ulcers are typically defined by the appearance of the ulcer, the ulcer location, and the way the borders and surrounding skin of the ulcer look.
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Venous Stasis Ulcers
Venous stasis ulcer usually occurs on the body below the knee. They are primarily found on the inner part of the leg, just above the ankle. Venous stasis ulcers may affect one or both legs. They appear red in color and may be covered with yellow fibrous tissue. There may be a green or yellow discharge if the ulcer is infected. Fluid drainage can be significant. They are usually irregularly shaped with the surrounding skin often discolored and swollen. It may even feel warm or hot. The skin may appear shiny and tight, depending on the amount of edema.
Venous stasis ulcers are common in patients who have a history of leg swelling, varicose veins, or a history of blood clots in either the superficial or the deep veins of the legs. Venous ulcers affect 500,000 to 600,000 people in the United States every year and account for 80 to 90 percent of all leg ulcers.
Neurotrophic (Diabetic) Ulcers
Diabetic ulcers are usually located at increased pressure points on the bottom of the feet. However, neurotrophic ulcers related to trauma can occur anywhere on the foot. Depending on the patient’s circulation they may appear pink/red or brown/ black. The skin of a diabetic ulcer appears “punched out”, while the surrounding skin is often calloused.
Neurotrophic (diabetic) ulcers occur primarily in people with diabetes, although they can affect anyone who has an impaired sensation of the feet. Diabetic foot ulcers are responsible for more hospitalizations than any other complication of diabetes. Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, with approximately 5% of diabetics developing foot ulcers each year with 1% requiring amputation.
Neuropathy and peripheral artery disease often occur together in people who have diabetes. Nerve damage (neuropathy) in the feet can result in a loss of foot sensation and changes in the sweat-producing glands, increasing the risk of being unaware of foot calluses or cracks, injury or risk of infection. Symptoms of neuropathy include tingling, numbness, burning or pain. It is easy to understand why people with diabetes are more prone to foot ulcers than other patients. This is why people with diabetes need to inspect their feet daily and wear appropriate footwear. People with diabetes should never walk barefoot.
A vascular surgeon and/or podiatric surgeon should evaluate all patients with diabetic foot ulcers so as to determine the need for debridement, revisional surgery on bony architecture, vascular reconstruction, or soft tissue coverage.
Arterial (ischemic) Ulcers
Arterial (Ischemic) ulcers occur on the foot, often on the heels, tips of toes, between the toes where the toes rub against one another or anywhere the bones may protrude and rub against bed sheets, socks or shoes. They also occur commonly in the nail bed if the toenail cuts into the skin or if the patient has had recent aggressive toe nail trimming or an ingrown toenail removed.
They have a yellow, brown, grey or black color and usually do not bleed. The borders and surrounding skin usually appear “punched out”. If irritation or infection are present, there may or may not be swelling and redness around the ulcer base. There may also be redness on the entire foot when the leg is dangled; this redness often turns to a pale white/yellow color when the leg is elevated.
Arterial ulcers are typically very painful, especially at night. You may instinctively dangle your foot over the side of the bed to get pain relief. The patient usually has prior knowledge of poor circulation in the legs and may have an accompanying disorder.