McKinney Diabetic Specialist Discusses Foot Ulcers

Foot Ulcers: What To Do If You Have One

When using the term "ulcer", we are generally referring to a break or hole in the the skin. Ulcers are skin wounds can be slow to heal and are classified in four stages, according to which layers of skin are broken through. Stage 1 ulcers are characterized by a reddening over bony areas. The redness on the skin does not go away when pressure is relieved. The area is not an open sore, but the patient can be predisposed to having an ulcer at the site. Stage 2 ulcers are characterized by blisters, peeling or cracked skin. There is a partial thickness skin loss involving the superficial layers of the skin. Stage 3 ulcers are characterized by broken skin and sometimes bloody, watery, or creamy drainage. There is a usually complete loss of the skin along with some of the subcutaneous tissue, which includes the fat layer under the skin that holds the blood vessels and nerves.
Stage 4 ulcers are characterized by breaks in the skin involving skin, muscle, tendon and bone and are often associated with a bone infection called osteomyelitis.How an ulcer feels is dependent on the underlying cause of the ulcer. For example, one of the more common types of ulcers is seen in patients with diabetes, who have loss of sensation in their feet. In this type of ulcer, there is little if any pain, due to a condition called diabetic neuropathy. In fact, diabetics typically get this type of ulcer because they've lost their protective pain sensation. Another common ulcer is due to loss of arterial blood flow to the leg, resulting in ischemic ulcers that can be very painful. So you can see that it very important to have any break in the skin properly evaluated and the lack of pain is not always a good initiator as to the severity of the problem. There are many different diagnostic tests that can be done in the course of treating an ulcer. If the ulcer appears to be infected, and the patient has redness, drainage, swelling, and pain, then a culture of the wound should be done. The reason for the culture is to identify the type of infection, so that you can be put on the appropriate antibiotic. If there is suspicion of the bone being infected under the ulcer, the doctor will do x-rays and other imaging modalities to determine the extent of the infection. If there is suspicion that the underlying reason for the ulcer is poor blood flow, then a studies to look at you blood vessels can be done. Ulcers occur due to different reasons, so it is very important to determine the underlying medical problem that caused the ulcer. There are essentially four main reasons people get ulcers on the foot. Neuropathic Ulcers: This is when a patient has loss of sensation in the feet. It is commonly seen in people with diabetes but it can be caused by other reasons such as chronic alcohol abuse. These ulcers are generally seen under weight bearing areas and often will begin as a callus or a corn. Arterial Ulcers: This type of ulcer is due to poor blood flow to the lower extremity. This type of ulcer can be very painful and are usually found on the tips of toes, lower legs, ankle, heel and top of the foot. They can very easily become infected. Venous Stasis Ulcers: This type of ulcer is due to poor veins. Veins are the vessels that take fluid out of the legs and back up to the heart. Veins have small valves that allow blood to flow only one way, back up to the heart. The valves normally block the tendency for gravity to pull the blood back down to the legs. Sometimes the valves leak or cease to work at all. If the valves do not work, then the fluid pools down in the legs, causing swelling. This swelling leads to increase pressure in the venous system, producing discoloration of the leg and eventually this lead to ulceration. They are commonly seen around the inside of the ankle and are slow to heal. Decubitus Ulcers: This type of ulcer is caused by excessive prolonged pressure on one area of the foot. The most common place to see this type of ulcer is in a person confined to bed and they occur on the backs of the heels. The best thing you can do for an ulcer is to have it looked at by your doctor, as soon as you can. The earlier that the ulcer is treated, the better chance you have at healing it.The first thing that will be done is to inspect the wound. The doctor is looking for signs of infection, location of the wound, the color of the tissue in the wound. This is all done to determine the best treatment for that wound. Once the cause of the ulcer is determined and all the necessary referrals are made, treatment of the ulcer can begin. The treatment will be tailored to the individual ulcer and it is often difficult to predict how long it will take an ulcer to heal. Sometimes patients have to be referred to a vascular specialist if the ulcer is due to poor blood flow. Sometimes a patient has to be sent to their diabetes doctor to get their blood sugars controlled. It takes a careful thought process by the podiatrist to determine the underlying etiology of the ulcer and point the patient in the right direction.
The best prevention is treating the underlying cause of the ulcer. That means if you are a diabetic, check your blood sugar daily and inspect your feet every day. If the reason for your ulcer is due to swelling in the legs, then you need to wear support stockings and keep your feet elevated as much as possible. If the ulcer is due to poor blood flow, treatment may be rendered to get more blood flow and oxygen to your feet. If the ulcer is due to pressure, finding ways to relieve that pressure is required.

Dr. Eric Silvers and Dr. Kory Williams see ulcerations daily and are well trained to treat all foot and ankle conditions. They can be reached at 972-542-2155 or you may visit our website at http://www.advancedfoottexas
Eric M. Silvers, DPM, PA
Board Certified Foot and Ankle Specialist
Advanced Foot and Ankle Center
McKinney, Texas
Prosper, Texas
http://www.advancedfoottexas.com
972-542-2155