Ulcers are the result of poor circulation in the affected area of your body, and most commonly occur in the legs and foot. Poor circulation may occur due to a variety of reasons including, but not limited to, vein disease and peripheral artery disease (PAD). Due to poor circulation, the affected area is deprived of its adequate supply of oxygen and nutrients which causes the area to become inflamed, forming an open wound.
What is an ulcer?
Ulcers are defined as abnormal breaks in the skin or mucous membrane. This long-lasting sore or wound is typically characterized as slow-healing or non-healing when it has taken more than 5 to 6 weeks to heal. Although leg ulcers can develop anywhere on the leg or foot, they usually develop on the inside of the calf, just above the ankle.
Types of ulcers
There are many different types of ulcers; however, we are going to focus on two, main ulcers that primarily affect the lower extremities.
- Arterial ulcers – These occur in arteries that carry oxygen and nutrients rich blood from the heart to all body organs and tissues while venous ulcers develop in the veins that bring back blood to the heart from body tissues for purification.
- Venous ulcers – These are more common than arterial ones, in fact, a high majority (80%) ulcers of the lower limb are venous ulcers.
Venous ulcers most commonly occur in the lower leg or upper part of the ankle. People who have a sedentary lifestyle may develop ulcers due to pooling of blood in the legs. Venous ulcers occur due to damage to the veins that have one-way valves to prevent the blood flow back from the heart. When these one-way valves get damaged due to some reason, this causes the leakage of fluid through the veins, resulting in swelling or edema. This swelling further prevents the flow of blood to the tissue in the leg, causing it to die and the ulcer forms. An ulcer is an example why treating underlying venous insufficiency is crucial.
Symptoms of Venous Ulcers
- Shallow wound
- Usually appear on the lower leg or ankle
- Itchy, dry skin
- Swelling, especially in the affected area
- Inflammation and redness before the wound progresses
- Achy, heavy feeling in the affected leg
- Skin discoloration
- The wound is flaky, but may continue to reopen
How to minimize venous ulcer complications:
- Examine feet, ankles, and legs regularly for non-healing wounds or discoloration
- Schedule an appointment with a vein specialist
- Tell your doctor if you’re taking heart medications that may increase your risk of swelling
- Exercise regularly and as frequently as comfortable
- Losing weight can help relieve excess pressure from the legs
- Quit smoking
- Practice leg exercises if you have to stand or sit for a long period of time
- Elevation can help temporarily relieve leg pain and discomfort related to venous ulcers
Arterial ulcers are formed due to blockage in arteries, mostly due to plaque buildup in them. Plaque consists of fat and cholesterol which often builds up in arteries due to sedentary lifestyle, unhealthy eating habits, smoking and obesity. As the process of plaque buildup (atherosclerosis) accelerates, arteries become narrower due to which the affected area doesn’t get nutrients which prompts the development of an ulcer. This condition is commonly known as Peripheral Artery Disease (PAD).
These painful ulcers are often found between or on the tips of toes, on the outer ankle or in the areas where you experience pressure while walking. Left untreated, the ulcers can cause infection or death of tissue (necrosis). In extreme cases, amputation of the leg may be needed.
Arterial ulcers often occur at the pressure points of the foot and affect toes or shin. They need to be kept dry, dry and clean in order to prevent the spreading of infection.
Symptoms of Arterial Ulcers
- Deep wound, sometimes through several layers of skin
- Wound edges are smooth
- Loss of hair on the legs
- Tenderness around the wound
- Red, yellow, or brown sores
- Leg may turn pale when elevated
- Affected area is cool to the touch
- Wound does not bleed
How to minimize arterial ulcer complications:
- Examine feet, ankles, and legs regularly for sores or discoloration
- Schedule an Ankle Brachial Index (ABI) test
- Exercise regularly and as frequently as comfortable
- Quit smoking as smoke hardens and clogs your arteries
- Wear footwear that fits correctly
- Manage your blood cholesterol, blood pressure, and glucose levels
Both arterial and venous ulcers are extremely prone to infection. It is important to contact a vein specialist if you notice a wound that is slow-healing or non-healing. Venous and arterial ulcers should be treated by a vascular or wound specialist; you should be careful about utilizing home remedies or ointments because these can sometimes make ulcers worse. Putting off treatment or waiting for your wound to heal naturally can be unsafe and cause the ulcer to become infected. After the wound is treated by a professional, it is important to fix the underlying condition through vascular treatment such as Endovenous Laser Treatment also known as EVLT or Stent Angioplasty. Without treating the underlying condition, ulcers may continue to develop in the future.
A vascular specialist is able to evaluate your ulcer’s direct cause and create a personalized treatment plan that fits your individual needs. If you think you may have underlying venous insufficiency or peripheral artery disease, call us or schedule an appointment online today.