What are ulcers? 

The easiest way to think of ulcers is to consider them abnormal holes in your body.  For example, most people know that a stomach ulcer is a hole in the lining of the stomach which causes pain from the stomach acid irritating exposed tissues. 

In podiatric medicine, however, our primary concern is not the stomach ulcer, but the kind of ulcer that affect the lower extremity (or foot and leg). 

There are three basic types of lower extremity ulcerations:  

We'll discuss each separately. 

NEUROPATHIC ULCERS
 

What's a neuropathic ulceration?

A neuropathic ulcer is an ulcer that develops because of diminished sensation (neuropathy) in the patient's foot.  Because they are associated with diminished sensation, neuropathic ulcers don't typically hurt much. 

Who gets neuropathic ulcers?

This sort of ulcer is usually as a result of diabetes or alcoholism, (though there are other possible causes). 

Where do you get them?

The most common location is on the bottom of the foot underneath weight bearing areas like the ball of the foot or heel.   

How do you treat them?

The primary treatment for this sort of ulcer is off-loading the foot (in other words, getting  all the weight off the ulcer), local wound care, and antibiotics when necessary.  

How do you prevent them?

It's best to prevent the neuropathy by controlling diabetes, discontinuing the use of excessive alcohol or addressing any other causes of the neuropathy.  Feel free to visit our web page on neuropathies

To learn how to classify this sort of ulcer and gain insight into the odds the wound will heal, please visit our web page on the UTSA ulcer classification system.  

ULCERS DUE TO VENOUS INSUFFICIENCY

What's an ulceration due to venous insufficiency?

The normal vein has valves that prevent the backflow of blood. When these valves break down because of long periods of excessive pressure, the backflow of venous blood develops.  This creates venous congestion and pressure, creating the ulceration over time.   These ulcers don't typically hurt too much. 

The discoloration seen with this sort of condition is a result of the iron in the hemaglobin inside the red blood cells oxidizing.  This creates iron-oxide (literally rust!), which causes the brownish discoloration commonly noted.

Who gets venous insufficiency ulcerations? 

Anyone with incompetent valves may get this sort of ulcer.  The classic patient is someone who stands long periods of time like a waiter or waitress, a clerk, and so forth.  

Where do you get them?

Typically on the inside portion of the lower leg.  

How do you treat them?

So long as the arterial circulation is adequate, local wound care and compressive  stockings are the treatment of choice.  

ULCERS DUE TO ARTERIAL INSUFFICIENCY

What's an ulceration due to arterial insufficiency? 

An ulcer that develops because of decreased blood supply to the leg.  

Who gets arterial insufficiency ulcerations?

Those with diminished circulation--like smokers, diabetics and the elderly. 

Where do you get them?

Wherever there is inadequate circulation, but the classic location is on the outside of the lower leg.  

How do you treat them?

Improve the blood supply.   This may be done by the patient's stopping smoking, prescription drugs or surgery.  

How do you prevent them?

The single biggest thing you can do is stop smoking, as this represent the largest group of patients with this sort of problem.