A skin ulcer is where an area of skin has broken down and you can see the underlying tissue. Most skin ulcers occur on the lower legs or feet. The skin normally heals quickly if it is cut. However, in some people with diabetes the skin on the feet does not heal so well and is prone to develop an ulcer. This can be even after a mild injury such as stepping on a small stone in your bare feet.
Types of Foot Ulcer
Venous ulcers are located below the knee and are primarily found on the inner part of the leg, just above the ankle.
The borders of a venous ulcer are usually irregularly shaped and the surrounding skin is often discolored and swollen. It may even feel warm or hot.
The skin may appear shiny and tight, depending on the amount of edema (swelling). The skin may also have brown or purple discoloration about the lower leg, known as “stasis skin changes.”
Neurotrophic 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. They occur primarily in people with diabetes although they can affect anyone who has an impaired sensation of the feet.
Diabetes can cause damage to the nerve and vascular supply in the feet and legs. Patients with neuropathy have reduced or no sensation and, therefore, might be unaware of any trauma to their feet caused by ill-fitting footwear or an object in their shoes, such as a piece of glass, a stone or a drawing pin.
Continued walking on an injured foot will damage it further and minor lesions can become more serious. A simple examination of the feet, feeling inside the shoes before wearing them and not walking barefoot can help to prevent minor injuries. Many of the patients attending the diabetes clinic are older and some cannot see, feel or reach their feet, which means that they are often unaware of any injuries
Diabetic foot ulcers are caused by neuropathic (nerve) and vascular (blood vessel) complications of the disease.
Nerve damage due to diabetes causes altered or complete loss of feeling in the foot and/or leg. This is known as peripheral neuropathy. Pressure from shoes, cuts, bruises, or any injury to the foot may go unnoticed. The loss of protective sensation stops the patient from being warned that the skin is being injured and may result in skin loss, blisters and ulcers.
Treatment options for all ulcers may include:
Antibiotics, if an infection is present
Anti-platelet or anti-clotting medications to prevent a blood clot
Topical wound care therapies
As a rule, the better the control of your diabetes, the less likely you are to develop complications such as foot ulcers. Also, where appropriate, treatment of high blood pressure, high cholesterol level, and reducing any other risk factors will reduce your risk of diabetes complications. In particular, you are strongly advised to stop smoking if you smoke.
Our feet keep us balanced and carry our weight. In a lifetime they walk as much as going five times around the earth. We should look after our feet before any of these problems creep in. Some of the serious foot problems may need the attention of a doctor. So, prevention is always better than cure.