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.
Symptoms of extremity ulceration may include:
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.
Evaluation for lower extremity ulcers/wounds should include:
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.