An ulcer is an opening in the skin; it is also known or described as a non-healing wound. There are three main types of ulcers that we see on the foot: 1) ischemic or arterial ulcers, 2) stasis or venous ulcers, and 3) neurotropic or diabetic ulcers.
- Ischemic ulcers:
- are wounds caused by an impaired blood supply, meaning that the arterial circulation, that has the job to bring oxygen and nutrients to the skin, is impaired. These wounds are typically painful, especially when the legs are elevated because gravity reduces the flow of blood even further. Do you know how these ulcers look like? These ulcers have a round punched-out appearance. Their base is yellow, grey or black. It is important to keep them dry and to make sure that they don’t get infected. Any Ideas on treatment ? Topical vasodilators to help increase the circulation in the area and revascularization surgery if indicated
- Stasis ulcers:
- on the other hand, are caused by venous insufficiency; meaning, veins are incapable of returning the blood from the lower extremities to the heart. What do these ulcer look like? These ulcers tend to be superficial with a lot of drainage and are often accompanied by hyperpigmentation (typically a red or purple discoloration) of the legs. How about treatments? Any guess? They can be treated by local wound care, compressive therapy, hyperbaric oxygen therapy, topical negative pressure, or wound vacuum, some oral medications, skin grafts and vascular surgery.
- Diabetic ulcers:
- are a little bit more complicated. Diabetes, especially when poorly controlled or uncontrolled, weakens the immune system, affects the blood vessel structure, and causes nerve damage. The nerve damage alters the sensation of the feet, causing numbness (commonly referred to as neuropathy). This results in the patient not feeling pain if he steps on a sharp object. Because of the altered sensation, it can take time for them to notice they even have a wound, increasing their chances of infection. The treatment for diabetic foot ulcers is local wound care, surgical debridement, offloading of the area, skin grafts if needed, and if there is presence of infection, antibiotics.
In conclusion, it is really important to recognize and treat these 3 types of ulcers, because when neglected, they can lead to infection, hospitalization, and possibly amputations. Furthermore, if you know you have risk factors that could lead to developing one of these types of lower extremity ulcers, make sure you are seen by a podiatrist to get more tips on how to prevent the ulcers from occurring.