How Are Foot Ulcers Treated?

Foot health is one of those issues that directly affects our general quality of life but is often neglected. Especially in individuals with chronic conditions such as diabetes or those experiencing circulatory disorders, foot ulcers can represent much more than a simple skin problem. Being aware of this condition, which can lead to serious infections and tissue loss if not intervened early, increases treatment success.

What is a foot ulcer?

A foot ulcer, generally referred to as a foot ulcer in medical literature, is an open sore that occurs below the ankle as a result of a breach in skin integrity. These ulcers may appear as superficial skin loss or may involve deep tissue loss extending down to the tendons and bones. These wounds, which are usually difficult and time-consuming to heal, develop as a result of underlying diabetes, vascular occlusion, or neurological problems. Untreated ulcers carry the risk of becoming infected and turning into gangrene, making them a health issue that must be taken seriously.

What causes foot ulcers?

While a single factor can be influential in the formation of foot ulcers, the process usually begins with the combination of several different conditions. The most common causes are:

• Diabetes is the greatest risk factor. High blood sugar causes nerve damage over time, leading to loss of sensation. Because the patient does not feel cuts or friction on the foot, the wound can grow.
• Circulatory disorders are also a significant factor. When sufficient clean blood and oxygen do not reach the foot due to arterial diseases, tissues cannot be nourished, and ulcers open even with the smallest impact.
• Venous insufficiency, i.e., vein problems, can cause stagnant blood to pool in the legs, weakening the skin and causing ulcers to open.
• Incorrect shoe selection and foot deformities create calluses and subsequently ulcers by applying excessive pressure to specific points.
• External factors such as trauma, burns, or fungal infections can also breach skin integrity and initiate wound formation.

Diabetic Foot

Diabetic foot is one of the most serious complications that arises when diabetes cannot be kept under control. Long-term high sugar levels in the blood damage the nerve endings in the feet over time, leading to a loss of sensation called diabetic neuropathy. Due to this loss of sensation, the patient does not feel an object piercing the foot, a rubbing shoe, a hot water burn, or a small cut. The inability to transmit the pain signal to the brain prevents the patient from taking precautions, and a small trauma can quickly turn into a deep, infected wound.

Another problem created by diabetes is the deterioration of vascular structure. High blood sugar causes calcification and narrowing in the arteries, laying the groundwork for peripheral artery disease. Reduced blood flow to the foot prevents tissues from being nourished and oxygenated. This situation makes it impossible for even the smallest wound to heal through the body’s own mechanisms. Along with the weakening of the immune system, diabetic foot ulcers quickly become infected, bringing the risk of gangrene.

Circulatory Disorders

Circulatory disorders, known as peripheral artery disease, are the most common cause of foot ulcers besides diabetes. When arteries narrow or become blocked due to reasons such as smoking, high cholesterol, or hypertension, sufficient oxygen and nutrient-rich clean blood cannot reach the extremities of the feet. This condition, called an ischemic ulcer, causes tissues to lose their vitality. These ulcers, usually seen on the tips of the toes or the heels, are quite painful and very difficult to heal unless blood supply is restored.

Venous Insufficiency

Venous insufficiency is the condition where the veins in the legs cannot pump dirty blood back to the heart against gravity. With the failure of the valves, blood pools in the legs and intravenous pressure increases. This high pressure impairs the nourishment of the skin over time, darkening its color and thinning the tissue. These ulcers, usually opening on the inner part of the ankle, are called venous ulcers. Unlike arterial ulcers, venous ulcers are generally shallow but can spread over a wide area and produce significant discharge.

Incorrect Shoe Selection and Foot Deformities

Wearing shoes that are not suitable for foot anatomy—those that are narrow, pointed, or have hard soles—for long periods applies constant friction and pressure to the skin. Especially in feet with deformities such as bunions, hammer toes, or flat feet, calluses form at the pressure points created by the shoe. Although a callus is a defense mechanism developed by the body against pressure, it damages the underlying tissue, leading to sub-dermal bleeding and ulceration. Patients with neuropathy do not feel this pressure, allowing ulcers to progress to the bone.

External Factors

Any external factor that breaches skin integrity can initiate the process of foot ulcer formation. Objects piercing the skin while walking barefoot, accidents while cutting nails, or burns resulting from contact with heat sources like stoves or hot water bottles destroy healthy tissue. Additionally, fungal infections between the toes (athlete’s foot) create cracks and fissures in the skin. These cracks act as a gateway for bacteria to enter under the skin, paving the way for serious cellulitis infections and deep wounds.

Symptoms of a Foot Ulcer

Foot ulcers can sometimes progress silently; patients with nerve damage may not feel pain. However, the following visual and physical symptoms should be monitored:

• Redness and increased heat in or around the wound area are among the first signs of infection.
• Edema and swelling may be seen in the foot or ankle.
• Yellow or greenish discharge leaking from the wound is usually accompanied by a foul odor.
• Changes in skin color, bruising, or blackening may indicate tissue death (necrosis).
• Hardened skin or callus tissue may be present around the wound.
• In advanced cases, systemic infection symptoms such as fever, chills, and general weakness may appear.

Which department treats foot ulcers?

Many departments are involved with foot ulcers. In the diagnosis and treatment phase, one can start with Interventional Radiology departments to avoid losing time. The process continues with the Orthopedics department regarding the need for foot debridement or amputation. Internal Medicine, Endocrinology, and Infectious Diseases also contribute to speeding up the process, especially in cases where diabetes is present.

Ozone or hyperbaric oxygen treatments should not be started before a correct diagnosis is made and Doppler ultrasonography is performed. Starting ozone or hyperbaric oxygen treatments while vascular occlusion exists without treating it first is not the correct approach.

How are foot ulcers treated?

In the treatment of foot ulcers, the primary stage is diagnosis; depending on the underlying cause, treatments for diabetic foot, venous ulcers, neuropathic wounds, or foot infections are planned and implemented.

Medication treatments are organized based on blood tests and culture results. After the underlying cause is treated, wound care is performed regularly by expert hands.

• Off-loading is the most critical point of treatment. Special insoles, shoes, or casting methods are used so that no pressure is placed on the wound.
• Regulation of blood circulation is necessary. If there is vascular occlusion, blood flow must be restored using methods such as balloons or stents.
• Wound care and dressing are performed at regular intervals using modern wound dressings. These dressings maintain the moisture balance of the wound and accelerate healing.
• Hyperbaric oxygen therapy and other auxiliary methods can be used as support in difficult-to-heal wounds by increasing the amount of oxygen reaching the tissues.

Debridement

Debridement is the process of removing dead, damaged, or infected tissues from the wound that prevent it from healing. Revealing healthy tissue is the most fundamental step for the healing process to begin. Since dead tissues provide a breeding ground for bacteria, antibiotic treatment or dressings cannot be effective unless they are cleaned.

Diabetic Foot Treatment

Diabetic foot treatment is a comprehensive process ranging from blood sugar control to surgical intervention. The first goal of treatment is to control the infection and regulate blood sugar. Because high sugar suppresses the immune system, it prevents the wound from healing. During this process, vascular surgery or angiography is vital; healing cannot be expected without ensuring blood flow if there is vascular occlusion.

Venous Ulcer Treatment

The cornerstone of treatment for venous ulcers is compression therapy. Compression stockings or multi-layer bandaging systems are used to support the upward pumping of blood accumulated in the leg. Elevating the leg above heart level (elevation) accelerates healing by reducing edema.

Neuropathic Wound Treatment

The most critical point in treating neuropathic wounds is the cleaning of calloused tissues and the complete removal of pressure over the wound. Medication treatments may be organized by a neurologist to soothe the patient’s neuropathic pain and slow down nerve damage.

Foot Infection Treatments

Before starting treatment, a wound culture test must be performed to determine the type of bacteria causing the infection. Accordingly, strong antibiotic treatment is started orally or intravenously. If there is an accumulation of abscess (pus) within the wound, it must be surgically drained.

How to prevent foot ulcers?

Treating a foot ulcer after it has formed is a difficult process; therefore, preventing it before it occurs is the most effective method. Things to consider are:

• Feet should be washed every day with lukewarm water and soap, and especially between the toes should be dried thoroughly. Fungi can form in areas that remain moist.
• The top and bottom of the feet should be checked every day with the help of a mirror; look for cuts, redness, or blisters.
• One should never walk barefoot. Slippers should be used even inside the house.
• Shoe selection is very important. Orthopedic shoes with soft leather that do not squeeze the foot and have a wide toe box should be preferred.
• Nails should be cut straight across; the corners should not be cut too deep.
• Blood sugar should be kept under control and smoking should be avoided. Smoking impairs blood circulation, increasing the risk of ulcers.