Leg ulcers are a complication of diabetes, appearing as open sores on the feet or lower legs. They arise from various factors related to the condition. Understanding these ulcers and their progression is important for preventing severe outcomes.
Identifying Diabetic Leg Ulcers
Diabetic leg ulcers often appear on specific areas of the feet, such as the bottom of the foot (under the big toe or ball of the foot), heels, or ankles. They can also develop on the lower legs. These wounds range from shallow abrasions to deep sores exposing bone or tendon.
The appearance of ulcers varies by cause and stage. Neuropathic ulcers, common in high-pressure areas, may start as a callus that breaks down, revealing a round, punched-out wound with a red or pink base. Surrounding skin may appear normal, making the wound seem less painful due to nerve damage.
Ischemic ulcers, resulting from poor blood flow, often appear on the toes or edges of the foot and can be painful. These wounds may have a pale or bluish base, surrounded by cool, shiny, hairless skin. Mixed ulcers combine features of both neuropathic and ischemic types.
Surrounding skin changes can include redness, swelling, warmth, or black tissue (eschar) indicating tissue death. The skin around the ulcer may also look dry, cracked, or discolored.
Underlying Causes in Diabetes
Physiological changes in diabetes contribute to leg ulcer development. Diabetic neuropathy, a type of nerve damage, often causes sensation loss in the feet. This reduced feeling means individuals might not notice cuts, blisters, or pressure points that could lead to skin breakdown.
Peripheral artery disease (PAD) is another factor, involving the narrowing of blood vessels that supply blood to the legs and feet. This reduced blood flow diminishes oxygen and nutrient delivery to tissues, impairing their ability to heal wounds. Even minor injuries can struggle to close without adequate circulation.
Individuals with diabetes often experience impaired immune function, making them susceptible to infections. When a wound occurs, the body’s ability to fight bacteria is weakened, allowing infections to take hold and spread easily. This prolonged inflammation further delays healing.
Foot deformities, such as bunions or hammertoes, can alter pressure distribution across the foot during walking. These abnormal pressure points create constant friction and stress, leading to skin breakdown and ulcer formation, especially when combined with neuropathy.
Recognising Other Warning Signs
Beyond the visible ulcer, other signs may indicate an issue. Any new drainage from a foot wound, particularly if cloudy, bloody, or pus-like, suggests a problem. An unusual or foul odor from the foot or a specific area can also signal an infection.
Systemic signs of infection, such as fever or chills, indicate the body is fighting widespread bacterial presence. Localized swelling, increased redness, or warmth around a specific area of the foot or leg suggests inflammation or infection.
Numbness or tingling in the feet or lower legs, often described as pins and needles, are common symptoms of diabetic neuropathy. These sensations, or their absence, indicate impaired nerve function that increases ulcer risk. Skin discoloration (bluish or purplish tint) or changes in skin temperature (one foot feeling colder than the other) can point to poor circulation.
Importance of Prompt Medical Care
Delaying professional medical evaluation for a suspected leg ulcer carries risks. Untreated ulcers can quickly become infected, leading to cellulitis, bone infections (osteomyelitis), or widespread infection (sepsis). These conditions can progress rapidly and become life-threatening.
In severe cases, prolonged infection and tissue death can lead to gangrene, which necessitates surgical removal of affected tissue or even amputation of a toe, foot, or lower leg. Early intervention improves the chances of successful healing and limb preservation.
Healthcare professionals who manage diabetic foot ulcers include primary care physicians, podiatrists, and wound care specialists. These experts can accurately diagnose the type and severity of the ulcer and develop a targeted treatment plan. Treatment goals involve controlling infection, removing dead tissue (debridement), alleviating pressure on the wound, and improving blood flow to the affected area.
Strategies for Prevention
Proactive measures can reduce the risk of developing diabetic leg ulcers. Daily foot inspections are important; individuals should check their entire foot, including between the toes and the sole, for cuts, blisters, redness, swelling, or changes in skin color. Using a mirror can help view hard-to-reach areas.
Proper foot hygiene involves washing feet daily with mild soap and lukewarm water, drying them thoroughly (especially between the toes), and applying moisturizing lotion to prevent dry, cracked skin (avoiding between toes). Wearing appropriate footwear is also important. Shoes should be well-fitting, comfortable, and provide adequate support, with seamless socks to prevent friction.
Maintaining stable blood sugar levels through diet, exercise, and medication management is important for preventing neuropathy and improving circulation and immune function. Regular physical activity, as advised by a doctor, can also enhance blood flow to the lower extremities. Avoiding walking barefoot, even indoors, protects feet from injury. Regular check-ups with a healthcare provider, including annual comprehensive foot examinations, allow for early detection of risk factors or nascent issues.