Foot Conditions A-Z
Foot ulcers are open sores that develop on the feet, usually as a result of loss of sensation (neuropathy) and compromised blood flow to and within the lower extremities. You are at increased risk of foot ulcers if you have diabetes or another condition that affects blood flow to the feet, such as peripheral arterial disease (PAD) or phlebitis (inflamed veins). Foot ulcers, which are the focus of this article, are not the same as pressure sores--also known as bed sores or decubitus ulcers--that occur when a person is immobile for an extended period in bed or in a wheelchair.
If you have diabetes or another condition that affects blood flow, your nerves or blood vessels may become damaged over time. That nerve damage can cause you to lose feeling in your feet. Yet the forces exerted on your feet -- primarily pressure and shear -- while standing, walking or doing other activities continue to act on your feet and produce blisters, lesions (skin breaks) or sores despite the fact that you cannot feel them.
You may not feel a cut, blister or sore, yet these foot injuries can cause ulcers. According to one report, “peripheral neuropathy and ischemia [reduced blood flow] combined with unrecognized repetitive trauma (e.g., ill-fitting shoes, unrecognized injury, ingrown toenails) lead to foot ulceration.” In people with diabetes who have foot symptoms, “the primary cause of foot ulcers… is peripheral neuropathy (up to 70%) and unrecognized repetitive trauma.” ("Management of Foot Ulcers in Patients with Diabetes," Journal of the American Pharmacists Association. 2000; 40(4)). In addition, if you lose feeling in your feet, you may not notice bruises or breaks in the ankle or foot bones that can cause joints to collapse, leading to serious gait alterations over time.
A foot lesion can also lead to an infection. If your blood vessels are damaged due to peripheral arterial disease (PAD) or another condition, your feet may not get enough blood and oxygen. This means if you do get an infection, your foot may not heal properly.
Fortunately, taking the right preventive steps can help protect you from foot ulcers and their consequences (see “Prevention and Treatment,” below).
Prevention and Treatment
The single most important way to prevent foot ulcers if you have diabetes is to control your blood sugar levels. High blood sugar creates the conditions—nerve and/or blood vessel damage--that can lead to ulceration. Other preventive steps include the following:
• Inspect your feet and legs daily. Look and feel for:
o Bumps, lumps, blisters or bruises;
o Cuts, sores, or cracked skin;
o Patches of thin or shiny skin (which can signal reduced blood flow) or areas of redness (especially red streaks, which can signal the presence of infection);
o Temperature differences (one part warm, another cold). This can signal lack of blood flow;
o Pain, tingling, numbness or no feeling at all. These can signal nerve problems;
o Ingrown toenails with red, puffy skin along the nail and tenderness or pain;
o Loss of hair on foot or leg, which can be a sign of reduced blood flow .
• IPFH suggests wearing only properly selected and fitted, as part of an integrated approach, padded socks with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional. Peer-reviewed, published studies have shown that wearing clinically tested padded socks can help protect against injuries to the skin/soft tissue of the foot, a major cause of diabetic ulcerations.
• See a foot care professional for regular foot examinations and preventive foot care.
In addition, IPFH suggests taking the following preventive steps:
• Check inside shoes daily for sharp points, sharp edges, seams or other rough areas or foreign objects that may lead to cuts, wounds or abrasions on your feet.
• If you have numbness, tingling or loss of feeling in your feet, be extra cautious. Make sure there are no sharp objects such as broken glass, nails, or exposed sharp edges on floors or in carpeting. Never walk or move around barefoot, even inside your house.
• Wash feet daily using lukewarm (never hot) water and mild soap. Use your elbow to test water temperature. After washing, dry feet thoroughly and keep them supple by applying lotion to the tops and bottoms of your feet. Do not attempt to cut toenails if you have neuropathy or other foot problems related to diabetes. See a podiatrist or other foot health professional regularly for toenail care and foot examinations. Never attempt to cut or file calluses or other protrusions on your feet.
• Never use wart removers or other harsh chemicals on your feet.
• Don’t cross your legs for extended periods, as this can reduce blood flow and create pressure points. For the same reason, don’t sit for more than an hour or two without changing positions.
• Walk as much as possible; doing so enhances circulation to the feet and helps with weight and blood sugar control.
If you have not been diagnosed with diabetes or other systemic issues or diseases, you should still inspect your feet daily, especially if your job requires you to spend extended time on your feet or you participate in recreational activities in which you spend time on your feet. As noted above, IPFH suggests that you follow an integrated approach in the selection of your padded socks and footwear.
If you have diabetic neuropathy or circulatory issues in your lower legs and feet and you notice areas of redness, sores that do not heal quickly or any breaks or lesions in the skin, see your doctor or a foot health professional immediately; do the same if you notice any open sores on your feet or legs. Left unattended, these sores and lesions can develop quickly into ulcers. Early detection through careful attention to blood sugar control and inspections of the feet and legs is critical to preventing ulceration and amputation.