Ronald W. Smith, M.D.

Ulcerations

ulcersI.      Definition:  Ulcers are breaks in the layers of the skin that are often slow to heal.  Ulcers can occur anywhere on the foot and ankle.   They occur on tips of toes, between toes, and the top of the toes.  They also occur on the bottom of the foot, the heel, and ball of the foot.  They can even occur in the arch of the foot when there are bony prominences.

II.      Cause:   The main causes of ulcers are problems with the nerves, poor arteries, or bad veins.   Nerve problems, which are dommon in diabetes, cause a loss of feeling.  Sores on the bottom of the foot are ignored because they don’t hurt and the sores develop into ulcers with continued walking.  Poor arteries cause bad circulation.  Skin at the top of the toes or between the toes breaks down and the ulcer develops.  Ulcers that occur around the ankle are often caused by bad veins.

III.      Treatment and Prevention:  Patients with vascular conditions should take precautions to prevent foot and leg ulcers.  They should examine their feet everyday in order to find and treat any areas of irritation or abrasions before the sores develop into ulcers.  Feet should be kept warm and proper footwear should be worn at all times to avoid rubbing and blistering.  Shoes should be wide, low-heeled, and properly fitted.  Avoid sitting with crossed legs and, if the ulcer is caused by vein problems, sit with legs raised whenever possible.  If an ulcer does develop, see your phsycian for treatment.  Ulcers should not be treated without professional guidance.  Your physician may use a number of treatment techniques, depending on the type of ulcer, to aid in the healing process.

•    The wound should be kept clean to avoid infection.
•    When the ulcer is caused by bad veins, compression dressings may be prescribed to keep swelling down.
•    A total contact cast may be used to aid in the healing process of diabetes related ulcers.  The cast is worn to distribute the weight evenly and take pressure off of the ulcer area.
•    These treatment techniques should be used in conjunction with treating the underlying cause of the ulcer, such as diabetes or arteriosclerosis.

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