One Foot At A Time
What are ulcers?
Ulcers are wounds or open sores that will not heal or keep returning.
What are the symptoms of ulcers?
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.
What are the types of leg and foot ulcers?
The three most common types of leg and foot ulcers include:
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.
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.
Leg ulcers may be caused by medical conditions such as:
First, the patient's medical history is evaluated. A wound specialist will examine the wound thoroughly and may perform tests such as X-rays, MRIs, CT scans and noninvasive vascular studies to help develop a treatment plan.
At Cleveland Clinic, patients are treated by a team of world-class experts in the Lower Extremity Wound Clinic in the Department of Vascular Medicine. This Clinic includes doctors, nurses and other medical specialists.
These experts work together to determine the cause of the ulcer and develop an individualized treatment program.
The goals of treatment are to relieve pain, speed recovery and heal the wound. Each patient's treatment plan is individualized, based on the patient's health, medical condition and ability to care for the wound.
Treatment options for all ulcers may include:
Venous ulcers are treated with compression of the leg to minimize edema or swelling. Compression treatments include wearing compression stockings, multi-layer compression wraps, or wrapping an ACE bandage or dressing from the toes or foot to the area below the knee. The type of compression treatment prescribed is determined by the physician, based on the characteristics of the ulcer base and amount of drainage from the ulcer.
The type of dressing prescribed for ulcers is determined by the type of ulcer and the appearance at the base of the ulcer. Types of dressings include:
Arterial ulcer treatments vary, depending on the severity of the arterial disease. Non-invasive vascular tests provide the physician with the diagnostic tools to assess the potential for wound healing. Depending on the patient's condition, the physician may recommend invasive testing, endovascular therapy or bypass surgery to restore circulation to the affected leg.
The goals for arterial ulcer treatment include:
Treatment for neurotrophic ulcers includes avoiding pressure and weight-bearing on the affected leg. Regular debridement (the removal of infected tissue) is usually necessary before a neurotrophic ulcer can heal. Frequently, special shoes or orthotic devices must be worn.
Patients are given instructions to care for their wounds at home. These instructions include:
Controlling risk factors can help you prevent ulcers from developing or getting worse. Here are some ways to reduce your risk factors:
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