There are four common types of ulcers (open sores) that can affect the legs and feet. Each type may look similar, but the causes and characteristics of each are very different. The four types of ulcers are: neuropathic, venous, ischemic, and pressure.
- Neuropathic ulcers: This ulcer type is the most common ulcer that is found in the foot. This type of ulcer can sometimes be called a diabetic ulcer, because there is a strong correlation between diabetes and peripheral neuropathy, which is the lack of sensation in the feet. This peripheral neuropathy is usually the cause of neuropathic ulcers. Since the patient is unable to feel pain in their feet, if there is an irritant to the foot, (common example: finding a screw or small trinket in the shoe) the patient will not know that they are continuously causing trauma to their feet, which will lead to the break down of skin and eventually result in an ulcer. In fact, once a patient has complete loss of sensation in their feet, the risk of neuropathic ulcers increases by 7 times.
- Venous ulcers: The previous blog addressed venous ulcers and the correlation with venous disease. So to quickly review, venous disease is the result of vein valve dysfunction, so blood is unable to be effectively pumped back to the heart, which leads to venous hypertension, which ultimately will cause the venous ulcer. Venous ulcers are more common in women than men and are the most common type of ulcer that affects the legs. Specifically, venous ulcers are usually found on the inside of the ankle due to the organization of the veins. There is usually no pain associated with these ulcers.
- Ischemic ulcers: Similarly to venous ulcers, these ulcers result due to problems with the vessels. However, these ulcers are caused due to a problem with the arteries, which most commonly is due to peripheral arterial disease. Peripheral arterial disease is the result of blockage in the arteries. The most common cause of this blockage is atherosclerosis, which is plaque build-up in the arteries. Patients who are older than 50 years old, have diabetes, smoke cigarettes, history of high blood pressure (hypertension), and/or have high cholesterol are at a higher risk of peripheral arterial disease, which ultimately puts them at a higher risk for an ischemic ulcer. Unlike venous ulcers, ischemic ulcers have a tremendous amount of pain associated with them due to the lack of blood supply to the area, which is called ischemia. These ulcers are most commonly found near the nail edges, in between the toes, and the front part of the legs.
- Pressure ulcers: This type of ulcer is most common in the elderly and is the result of immobilization (such as being in a cast that is too tight or wheel chair), hospitalization, and inadequate nursing home care. Twenty percent of these ulcers are found on the back portion of the heel. When lying down the heels have a lot of pressure placed on them and this continuous pressure leads to tissue ischemia, because the blood flow will be diminished, which is similar to the ischemic ulcers. In addition, friction and shear forces, which may be caused when moving a patient, may also cause a pressure ulcer. These ulcers are sometimes also referred to as bed sores. Many cases can be avoided by proper care during hospitalizations and nursing home stays, by preventing the patient from staying in the same position for long periods of time, as well as being careful when moving the patient.
Ulcers can be difficult to treat and there is no self-treatment, so if you have what you believe to be an ulcer or any other open wound, see Platte Valley Foot and Ankle Clinic immediately.