Foot and leg ulcers

Health and Nutrition > Diseases > F Reviewed by Dr Stephen Collins, GP



Ulcers are breaks in the layers of the skin that fail to heal. They may be accompanied by inflammation.

Sometimes they don't heal and become chronic. Chronic foot and leg ulcers mainly affect the elderly.

People with diabetes are at special risk of developing foot ulcers, and foot care is an important part of diabetes management.

What causes ulceration?

The most common cause of chronic leg ulcers is poor blood circulation in the legs. These are known as arterial and venous leg ulcers.

Other causes include:

- injuries - traumatic ulcers
- diabetes - because of poor blood circulation or loss of sensation (nerve damage) resulting in pressure ulcers
- certain skin conditions
- vascular diseases (stroke, angina, heart attack)
- tumours
- infections.

Arterial leg ulcers

Approximately 10 per cent of all leg ulcers are arterial ulcers.

Feet and legs often feel cold and may have a whitish or bluish, shiny appearance.

Arterial leg ulcers can be painful. Pain often increases when your legs are at rest and elevated.

You can reduce pain by sitting on the edge of the bed with your feet on the floor. Gravity will then cause more blood to flow into your legs.

What causes arterial leg ulcers?

Diabetes and ulcers The long-term effect of diabetes on the nerves increases the likelihood of trauma to the feet.

It causes a lack of sensation in the feet, which makes ulcers more likely to appear.

But these ulcers are often neglected because they don't cause pain.

If ulcers aren't treated, they can lead to more serious problems.

What can trigger or worsen arterial leg ulcers?

- Smoking.
- High blood pressure.
- Diabetes.
- Arthritis (rheumatoid arthritis).
- Old leg ulcers.
- Coronary heart disease, including coronary thrombosis (blood clots in the arteries of the heart).
- Atherosclerosis in the legs.

What can I do to prevent arterial leg ulcers?

Claudication People with arterial leg ulcers often suffer from intermittent claudication.

The condition causes cramp-like pains in the legs when walking.

This is because the leg muscles don't receive enough oxygenated blood to function properly.

Claudication pain usually goes away if you stand still for a few minutes.

Not all people with intermittent claudication have leg ulcers.

Venous leg ulcers

Approximately 70 per cent of all leg ulcers are venous ulcers. A leg with venous problems has a very characteristic appearance:

- the leg is swollen.
- the skin surrounding a venous ulcer is dry, itchy and sometimes brownish in colour.

- eczema may appear (varicose eczema).
- the ulcer has a weeping, raw appearance and is usually painless unless infected.
- venous leg ulcers are often located just above the ankle, typically on the inside of the leg.

What causes venous leg ulcers? Most of venous leg ulcers occur because the valves connecting the superficial and deep veins are not functioning properly.

The venous system is made up of superficial and deep veins:

- superficial veins are located between the skin and the muscles
- deep veins are located between the muscles.

Superficial and deep vein systems are connected to each other by veins that have one-way valves.

These valves normally ensure that blood flows from the superficial veins to the deep system.

Failure of these valves causes blood to flow from the deep veins back out to the superficial ones - a major cause of varicose veins.

When you walk or exercise, the calf muscles push venous blood back to the heart.

What can trigger or worsen a venous leg ulcer?

.

- Old ulcers that may have damaged part of the venous system.
- A fracture or other injuries.
- A blood clot in the deep veins (deep vein thrombosis).
- Surgery.
- Work that requires a lot of sitting or standing.
- Inflammation in the veins (phlebitis), especially in the deep veins.
- Pregnancy - the more pregnancies, the higher the risk.
- Obesity.

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