Examining the Different Types of Ankle and Foot Ulcers
These types of ulcers are open sores that develop when skin tissue breaks down and exposes the layers beneath. Ankle and foot ulcers are generally classified into three types: arterial, neurotrophic, and venous. Treating an ulcer at its earliest stages can prevent infection from spreading and reduce the risk of amputation, so, it’s important to see our Keller podiatrist right away.
They will physically examine your feet and review your medical history to diagnose the type of ulcer you have. If there are signs of infection, blood tests or a wound culture may be ordered. If the infection has spread, imaging tests may be ordered to determine if the infection has spread to the bone. Each type of ulcer may have slightly different treatment needs depending on the wound's underlying cause, location, and severity.
Arterial ulcers can develop if the arteries are narrowed by plaque due to peripheral arterial disease, which can prevent wounds from healing properly due to poor blood supply. These types of ulcers can appear on the heels, toes, between the toes, and any other area where an injury or damage has occurred.
Characteristics of an Arterial Ulcer
- A wound that has a punched-out appearance and may be red, black, brown, gray, or yellow
- The ulcer itself typically does not bleed
- The affected leg or foot where the ulcer has developed may become pale when elevated and turn red when hanging downward
- There is little to no hair growth on the limb where the ulcer is present
- The skin may feel cool to the touch and feels tight
Complications if an Arterial Ulcer Is Left Untreated
- Tissue death
Treatment Options for an Arterial Ulcer
- Antibiotics to treat the infection
- Special shoes or custom orthotics to keep pressure off the affected limb
- Bandages or loose dressing to cover the wound
- Consistent dressing changes to keep the wound clean and dry
In severe cases where blood flow is restricted, surgery may be needed to restore circulation. In cases where blood flow cannot be restored or infection has spread and cannot be controlled, amputation may be needed.
Neurotrophic ulcers occur in areas of the feet that are most sensitive to pressure and weight, particularly the bottoms of the feet. These ulcers affect those with nerve damage, but especially those patients with diabetes. Because these ulcers often develop in people with a lack of feeling in their feet, they can be challenging to detect. Most neurotrophic ulcers do not cause pain, so detecting and treating one at its earliest stages is important to prevent severe complications.
Characteristics of a Neurotrophic Ulcer
- Borders are thin and raised above the surface of the surrounding tissue creating a punched-out appearance
- Color such as pink, red, black, or brown
Treating a Neurotrophic Ulcer
- Antibiotics to stop the spread of infection
- Debridement to clean out any dead tissue or debris in the wound
- Loose dressing to cover the wound and allow it to breathe
- Special shoes to decrease pressure
The most common type of foot/leg wound, venous ulcers are usually found above the ankle on the inner part of the leg. Patients who develop these ulcers often suffer from deep vein clots or varicose veins. When the veins in the legs don’t push blood to your heart in the proper way, blood can back up in the veins, causing pressure. This buildup of pressure and excess fluid can create an open sore.
Characteristics of a Venous Ulcer
- Irregular shape
- Surrounding skin may be hard and discolored
- Wound may ache or itch
- Drainage from the wound
- Signs of swelling
- Foul odor
Venous ulcers typically do not heal on their own and can result in permanent tissue damage. If the ulcer is slow to heal, the risk of infection increases. When an ulcer becomes infected, it can spread to surrounding tissue or bone and cause complications such as gangrene or amputation.
Treating a Venous Ulcer
- Oral and topical antibiotics to treat and prevent infection
- Compression stockings or bandages to improve circulation and promote healing
- Daily wound cleaning; keeping the wound covered
- Debridement to remove dead tissue and debris from the wound (see video below)
- Pain medication to control pain
- Blood sugar levels kept under control
Foot Ulcer Prevention Tips
Not all foot/ankle ulcers can be prevented, and often they recur even after treatment. For diabetic patients, the risk of recurrence is 60%. Those who’ve had one ulcer have a very high risk of developing another. Here are some tips to help reduce your risk:
- Make lifestyle changes such as eating healthy and exercising regularly
- Maintain a healthy weight
- Stop smoking
- Do a daily self-check of your feet
- Wear socks to protect your feet and shoes that fit properly
- Keep your blood sugar levels under control
- See a podiatrist at the first sign of a foot problem
- Bonus tip: try Siren Socks to help detect ulcers (see video below)
Contact Our Grapevine or Keller Podiatrist for Help
If you have signs of ankle or foot ulcers, contact Alliance Foot & Ankle Specialists for a consultation. We can answer your questions and create a custom treatment plan based on your specific needs. Contact our Grapevine or Keller office to request an appointment by filling out our convenient online contact form or calling our office at 817-481-4000.