An ulcer is an open sore on the skin that does not heal properly or is delayed in healing. An ulcer can form on the foot due to poor circulation, loss of nerve supply, pressure from too-tight shoe-gear or an injury. According to the Cleveland Clinic, diabetes and arterial or venous insufficiency are the most common disease processes responsible for the formation of foot ulcers. An ulcer on the foot is a serious condition. If an ulcer is left untreated it can lead to further problems, such as infection or even amputation.
Evaluation of the Ulcer and X-ray Examination
The first step in any treatment regimen is the evaluation of the problem, and ulcers are no exception. According to American Academy of Family Physicians, foot ulcers are usually defined by their appearance, size, location, depth and their edges. The severity of the ulcer will determine how aggressively it is treated. The ulcer will also need to be probed for any sinus tracts leading down to the bone. If any sinus tracts are found, or there is a substantial infection present, the foot should be X-rayed to determine if the bone below the ulcer has been affected. An MRI may be necessary if the infection is very deep.
Debridement and Wound Dressing
Debridement is the medical name for the scraping away of any dead skin or infected tissue around the ulcer. It is typically done using a scalpel and acts to stimulate wound healing. Topical dressings are then applied to protect the ulcer, absorb any fluids, keep it clean and reduce the chance of infection. Wound dressings may also include foam, hydrogel or calcium alginate.
Off-Loading or Compression
In order for some foot ulcers to heal, the pressure around the ulcer needs to be greatly reduced. Pressure on an ulcer can slow its healing and increase the risk of complications. Diabetics may not feel the pressure, so it is especially important for diabetic foot ulcers to be off-loaded. Off-loading can be accomplished by using crutches or a wheelchair, but it is also possible to relieve pressure with a total contact cast, or TCC. TCCs are difficult to apply, but can be very effective. Once the ulcer is healed, custom-made shoes can be beneficial in reducing pressure on the foot.
When dealing with a foot ulcer caused by venous insufficiency, compression garments are used to aid the ulcer in healing.
Antibiotics and Anti-platelet Medication
Even with proper treatment, some foot ulcers will become infected. Depending on the severity and type of infection, oral or topical antibiotics may be prescribed. Anti-platelet medication to prevent clots may be necessary when treating a venous ulcer.
Cellular Therapy
Cellular therapy may be used when a foot ulcer refuses to heal. According to Columbia University Medical Center, cell therapy such as Apligraf, classified as a human skin replacement, may be placed over the ulcer. The graft contains special cells, keratinocytes and fibroblasts, which stimulate the skin to heal. It is used for diabetic and venous ulcers and is quite effective when used on chronic ulcers.
