What are ulcers?
Ulcers are wounds or open sores that will not heal or keep returning.
What causes leg ulcers?
Leg ulcers may be caused by medical conditions such as:
- Poor circulation, often caused by arteriosclerosis
- Venous insufficiency (a failure of the valves in the veins of the leg that causes congestion and slowing of blood circulation in the veins)
- Other disorders of clotting and circulation that may or may not be related to atherosclerosis
- Renal (kidney) failure
- Hypertension (treated or untreated)
- Lymphedema (a buildup of fluid that causes swelling in the legs or feet)
- Inflammatory diseases including vasculitis, lupus, scleroderma or other rheumatological conditions
- Other medical conditions such as high cholesterol, heart disease, high blood pressure, sickle cell anemia, bowel disorders
- History of smoking (either current or past)
- Pressure caused by lying in one position for too long
- Genetics (ulcers may be hereditary)
- A malignancy (tumor or cancerous mass)
- Certain medications
What are the types of leg and foot ulcers?
The three most common types of leg and foot ulcers include:
- 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.
Venous Stasis Ulcers
- Location on body: Below the knee - primarily found on the inner part of the leg, just above the ankle. Ulcers may affect one or both legs.
- Base: 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.
- Borders: Usually irregularly shaped. 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).
- Who is affected: 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
- Location on body: Usually located at increased pressure points on the bottom of the feet. However, neurotrophic ulcers related to trauma can occur anywhere on the foot.
- Base: Variable, depending on the patient's circulation. It may appear pink/red or brown/ black.
- Borders: Punched out, while the surrounding skin is often calloused.
- Who is affected: Neurotrophic ulcers occur primarily in people with diabetes, although they can affect anyone who has an impaired sensation of the feet.
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.
Arterial (ischemic) Ulcers
- Location on body: On the feet - 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.
- Base: Has a yellow, brown, grey or black color and usually does not bleed.
- Borders: 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. The patient may instinctively dangle his/her foot over the side of the bed to get pain relief.
- Who is affected: The patient usually has prior knowledge of poor circulation in the legs and may have an accompanying disorder, such as those listed in the section, "What causes leg ulcers?"
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.