Care for Foot Ulcers

Foot ulcers are an open wound on the foot and are a fairly common problem for individuals with diabetes as well as older patients with poor circulation. We see a fair amount of them in the podiatry field, but the causes of foot ulcers and methods of treatment vary greatly depending on the individual case and patient.  The ultimate goal when it comes to the problem of foot ulcers is prevention through various means.

The primary risk of an ulcer wound is the possibility of infection. Because open ulcer wounds are an ideal breeding ground for bacteria they are at risk of becoming infected and gangrenous. Such cases likely require immediate surgical intervention, and in the worst cases, amputation. Amputation is a last resort, and if treated in a timely manner, an unlikely outcome.

There are a few different stages of a foot ulcer that doctors and insurance companies may use to categorize severity and priority. The stages of development of a foot ulcer wound are as follows:

Stage 1 – Callous, Corn, or other Hyperkeratotic Lesion

Foot ulcers often start as just a callous or corn in the foot. The name corn comes from the common description of a callous that is kernel shaped, and patients often describe the sensation of walking on a pebble. If the callous or corn contains a sharp point it can make walking painful and limit mobility. Corns and callouses are a form of hyperkeratotic lesion, which is a patch of keratin heavy thickened skin. The lesion is, at this stage, closed, but if left untreated it can break the skin and cause a stage 2 ulcer.

Stage 2 – Open Ulcer

The second stage of a foot ulcer is designated by a break in the skin leading to bleeding as well as the potential for infection. The larger and deeper a foot ulcer becomes the more access bacteria has to take root in the wound and cause severe infection. This is a crucial time for treatment as the development to stage 3 further complicates treatment of the issue.

Stage 3 – Deep Ulcer & Infection

At this stage, the ulcer has opened, and has been exposed for a significant amount of time, leaving the patient susceptible to severe infection and/or gangrene. Stage 3 is denoted by the ability to see either bones or tendons inside the ulcer. At this point infection rates are very high and bacteria has likely had an opportunity to thrive within the open wound. When a stage 3 foot ulcer occurs, it leaves the patient susceptible to developing an in-bone infection known as osteomyelitis. This kind of infection breaks down the bone material within the foot and eats away at the bone itself. Gangrene occurs when that that infection becomes extremely severe.

This severe infection is difficult to treat and in certain cases the podiatrist may refer out to an infectious disease doctor. The exposed bone, tendons, and tissue of a deep foot ulcer acts as an ideal environment for bacteria to propagate. While treatment for these extreme scenarios vary, osteomyelitis may require the removal of bone fragments in order to combat the infection, and in extremely severe cases amputation of the bone or limbs is required. Our primary goal is the prevention of amputation and limb salvage at all costs. Preventative precautions are always preferred over invasive procedures.

What to Do Early On

If you identify a mild foot ulcer and cannot immediately see a podiatrist, one thing you can do in the interim is soak your foot for 5-10 minute in Epsom salt. This applies to any open sores or cuts, but it’s not a replacement for medical attention that is required to treat the issue. Doing so will simply help to prevent or slow down bacterial infections if you need to wait a short period of time before your appointment. You can also apply Neosporin which contains a mild antibiotic – it’s best to then cover the open wound with a band-aid.

After Foot Ulcer Treatment

Once a podiatrist treats such a mild, extreme, or severe foot ulcer, it’s of the utmost importance to continue to see the podiatrist even after the wound is healing and feeling better. As part of the natural ongoing healing process of an ulcer, necrotic tissue may be present on the ulcer that must be removed by a medical professional to ensure re-infection or further infection does not occur. Additionally, a round of antibiotics may be prescribed as part of on-going treatment in the case of an infection.

Your podiatrist may also prescribe anti-bacterial ointment or an ointment with good growth factors in order to help close the wound and speed up the recovery process. Bandages may need to be changed regularly as per the instructions of your Podiatrist. Aftercare and treatment measures depend on the stage, severity, and cause of the food ulcer, but in cases of severe swelling a zinc bandage wrap may be used to treat an open wound. Such treatment would require the bandages to stay on for an average of a week and may also be used in conjunction with a medical boot.

Osteomyelitis Before & After

Osteomyelitis, or an in-bone infection, can be often be seen on an x-ray as the bone may already be in the process of being eaten away by bacteria. If the infection feels red hot that is another sign of a bone infection. If left untreated, osteomyelitis can cause gangrene to occur inside the foot. It is possible to clear an in-bone infection but it’s of the utmost importance to continue to see your Podiatrist afterwards as the infection has a chance of coming back. If a chronic infection occurs, it may be necessary to complete remove a section of bone or amputate as a life-saving measure.

Continuing Care

One of the best methods to avoid another ulcer from forming is through preventative care and identifying the root cause of the issue. Many podiatrists may recommend a custom medical orthotic device to help support good foot function and prevent further corns, callouses, and ultimately ulcers. This applies doubly so to diabetic patients who can experience further podiatric complications due to their condition.