Ulcers are skin wounds that are slow to heal. In the foot, as prominent metatarsal heads on the plantar (bottom of the foot)are subjected to increased pressure, the skin begins to become calloused. When subjected to shearing forces, there is a separation between the layers on this calloused skin, which fills with fluid and becomes contaminated and infected and eventually breaks open. The result is a foot ulcer.
There are also four major causes of foot ulcers:
- Neuropathic—Related to the nerves and characterized by a loss of sensation in the feet.
- Arterial—Related to poor blood circulation to the lower extremity. This type of ulcer can be very painful and is usually found on the tips of toes, lower legs, ankle, heel, and top of the foot. It can very easily become infected.
- Venous—Related to compromised veins. These ulcers are often seen around the inside of the ankle and on the lower leg and are slow to heal.
- Decubitus—Derived from excessive and prolonged pressure on one area of the foot. The most common type of decubitus ulcer of the feet is bed sores on the backs of the heels of people confined to bed for long periods of time.
Foot ulcers are a common problem for diabetics. Debridement of devitalized tissue, topical wound medications, antibiotics, off-loading methods, and proper shoegear/immobilization techniques are essential for healing.