Wounds / Ulcers
Ulcers are skin wounds that are slow to heal. In the foot, as prominent metatarsal heads on the plantar (bottom of the foot) are subjected to increased pressure, the skin begins to become callused. When subjected to shearing forces, there is a separation between the layers on this callused skin, which fills with fluid and becomes contaminated and infected. The result is a foot ulcer.
Ulcers are classified in four stages, according to how deeply they penetrate the layers of skin they have broken through.
The four stages of ulcers are:
Stage 1 — Characterized by reddening wounds over bony areas. The redness on the skin does not go away when pressure is relieved.
Stage 2 — Characterized by blisters, peeling, or cracked skin. There is a partial thickness skin loss involving the top two layers of the skin.
Stage 3 — Characterized by broken skin and sometimes bloody drainage. There is a full thickness skin loss involving subcutaneous tissue (the tissue between the skin and the muscle.)
Stage 4 — Characterized by breaks in the skin involving skin, muscle, tendon, and bone and are often associated with a bone infection (osteomyelitis).
The are also four major cause of foot ulcers:
Neuropathic—Related to the nerves and characterized by a loss of sensation in the feet.
Arterial—Related to poor blood circulation to the lower extremity. This type of ulcer can be very painful and is usually found on the tips of toes, lower legs, ankle, heel, and top of the foot. It can very easily become infected.
Venous—Related to compromised veins. These ulcers are often seen around the inside of the ankle and are slow to heal.
Decubitus—Derived from excessive and prolonged pressure on one area of the foot. The most common type of decubitus ulcer of the feet is bed sores on the backs of the heels of people confined to bed for long periods of time.
If you have diabetes or poor circulation, a small blister could turn into a big problem quickly! Foot ulcers are a common problem for diabetics. Contact casts are sometimes applied to the diabetic foot to relieve the bony prominent areas of pressure, allowing ulcers to heal.
Most blisters on the feet are caused by friction and do not require medical attention. New skin will form underneath the affected area and the fluid built up in the blister is simply absorbed back into the tissue. You can soothe ordinary blisters with vitamin E ointment or an aloe-based cream.
Do not puncture a blister unless it is large, painful, or likely to be further irritated. If you have to pop a blister, use a sterilized needle or razor blade. Wash the area thoroughly, then make a small hole and gently squeeze out the clear fluid. Apply a dab of hydrogen peroxide to help protect against infection. Do not remove the skin over a broken blister. The new skin underneath needs this protective cover. Cover the area with a bandage and mild compression.
If the fluid is white or yellow, the blister is infected and needs medical attention.
You can prevent blisters by breaking in new shoes gradually, and putting petroleum jelly or an adhesive bandage on areas that take the rub—before the blister happens. Wear socks that have heels instead of tube socks (they bunch up and cause blisters). Acrylic and other synthetic-fiber socks are good choices. Be sure to wash and dry your feet daily to prevent bacterial infections, such as Athlete's Foot.
Your Chiropodist is an expert in properly assessing and treating wounds. There are some steps you can take to help avoid wounds altogether.
Look for signs of redness or blisters on your feet and report it to us. If you can't see the bottom of your feet try using a mirror.
If you are unable to reach your toes, do not have feeling in your feet, or have vision problems, have our Chiropodist trim your toenails for you.
When you visit our clinic with a wound, our Chiropodist will complete a full assessment of both feet including your wound. From these observations a treatment plan will be developed based on your specific needs. You will then be monitored as needed to ensure you are progressing well and that no infection has begun. If an infection should occur, your Chiropodist may prescribe antibiotics or other treatments to get you on the road to recovery.