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What Causes Leg/Foot Ulcers?
Leg/foot wounds or ulcers may begin with a small area of skin breakdown from trauma or pressure on a particular area. Patients with diabetes, history of smoking, and cardiovascular risk factors are more prone to developing ulcers that may not heal due to lack of blood flow to the area of the ulcer/wound. A non-healing ulcer places the limb at risk for infection, gangrene (dead tissue) and limb loss (amputation).
Wounds that do not heal within 30 days are considered non-healing and evaluation for peripheral artery disease (blockage) as well as venous disease is indicated.
What are the Symptoms of Leg/Foot Ulcers?
Symptoms of extremity ulceration may include:
• Skin breakdown (sometimes with fat or bone exposed)
• Pain in the area of the ulcer
• Drainage
• Swelling
• Weeping
Concomitant peripheral artery disease may result in leg pain/discomfort worse with walking/exertion, relieved by rest, skin changes, decreased pulses, and a pale appearance of the wound with little bleeding.
What Kinds of Diagnostic Tests are Usually Performed For Leg/Foot Ulcers?
Evaluation for lower extremity ulcers/wounds should include:
• Ankle-Brachial Index (ABI)
• Lower extremity artery ultrasound
• CT and/or MR angiography
• Angiography
• Wound care center referral
• Podiatry and/or orthopedics referral
• Lower extremity venous ultrasound (as indicated)
What are the Treatment Options for Leg/Foot Ulcers?
Treatment for non-healing lower extremity ulcers/wounds should involve a multi-disciplinary team that may include a vascular specialist, wound care physician, podiatrist, orthopedist, and infectious disease specialist. If arterial blood flow to the area of the non-healing ulcer is compromised, catheter-based treatments (atherectomy, angioplasty, stenting) and/or bypass surgery may be indicated to restore blood flow to allow for healing.