What are ulcers?
Ulcers are wounds or open sores that will not heal or keep returning.
What are the symptoms of leg and foot ulcers?
Ulcers sometimes cause pain. If you have an ulcer, your leg will likely be swollen and it may itch or burn. You may also notice a rash, redness, brown discoloration or dry, scaly skin.
Are all leg and foot ulcers the same?
There are three common types of ulcers that affect the feet and legs. These are:
- Venous stasis ulcers.
- Neurotrophic (diabetic) ulcers.
- Arterial (ischemic)ulcers (ischemic ulcers).
Three things help define an ulcer:
- Location on the body.
- Appearance of the ulcer.
- Appearance of the borders and surrounding skin.
Venous stasis ulcers
Venous stasis ulcers are the most common type of leg ulcers. They affect more than 500,000 people in the United States each year. They are common in patients who have a history of swollen legs, varicose veins or blood clots in the veins inside the legs.
Location on body
Below the knee - most common on the inner part of the leg, just above the ankle. Ulcers may affect one or both legs.
What the ulcer looks like
Red and possibly covered with yellow, fibrous tissue. There may be a green or yellow discharge if the ulcer is infected. There may be a lot of drainage.
Borders and surrounding skin: Usually irregular in shape. The surrounding skin is often discolored and swollen, and can feel warm/hot. The skin may be shiny and tight, depending on the amount of swelling.
Neurotrophic (diabetic) ulcers
Neurotrophic (diabetic) ulcers are most common among people with diabetes. But, anyone who has less than normal sensation in the feet can develop this type of ulcer. This loss of feeling is caused by nerve damage (neuropathy). Neuropathy can also cause changes in the sweat glands. The combination of the loss of feeling and these changes can cause patients to have calluses, cracks or other problems with their feet that they don’t know about. This increases the risk of infection. Many patients with diabetes have both neuropathy and peripheral artery disease. If you have diabetes, it is very important to check your feet on a regular basis, avoid going barefoot and wear proper shoes. Also, be aware of symptoms of neuropathy, such as tingling, numbness, burning and pain.
Location on the body
Usually found on the bottom of the feet in areas where there is a lot of pressure, but can appear anywhere on the feet.
What the ulcer looks like
Color can vary from pink/red to brown/black. The color depends on the amount of blood flow to the feet.
Borders and surrounding skin: The borders look punched out and there are often callouses on the surrounding skin.
Arterial (ischemic) ulcers
Arterial (ischemic) ulcers affect patients with poor circulation in the legs. The circulation problem may be caused by another condition (See "What Causes Leg and Foot Ulcers?" on this page). This type of ulcer usually causes a lot of pain, especially at night. If you have this type of ulcer, you may find that dangling your feet over the side of the bed can help relieve the pain.
Location on body
On the feet - often on the heels, tips of toes, between the toes where the toes rub against one another or anywhere the bones stick out and rub against bed sheets, socks or shoes.
Arterial ulcers can also appear in the nail bed if the toenails are cut very short or if there is an ingrown nail or one that cuts against the skin.
What the ulcer looks like
Yellow, brown, gray or black. The ulcer usually does not bleed.
Appearance of the borders and surrounding skin: Both usually look punched out, and the area may be red or swollen. The whole foot may become red when it is dangling, but turn white/yellow when it is up.
What causes leg and foot ulcers?
Your risk of getting ulcers is higher if you have:
- Poor circulation, often caused by arteriosclerosis.
- Venous insufficiency (a problem with the valves in the veins inside the legs that affects blood flow).
- Other clotting and circulation problems that may be related to atherosclerosis.
- Diabetes.
- Kidney (renal) failure.
- High blood pressure (hypertension), even if you are being treated for the condition.
- Lymphedema (a buildup of fluid that causes swelling in the legs or feet).
- Inflammatory diseases, such as vasculitis, lupus, scleroderma and other rheumatologic conditions.
- Other medical conditions, such as high cholesterol, heart disease, high blood pressure, sickle cell anemia and bowel disorders.
- History of smoking (current or past).
- Pressure caused by lying in one position for too long.
- A family history of leg and foot ulcers.
- Cancer.
- Infection.
Certain medications can also increase your risk of developing leg and foot ulcers. Talk to your doctor if you have any questions or concerns about your risk of ulcers.
How are leg and foot ulcers diagnosed?
If you have a possible leg or foot ulcer, a wound specialist will closely examine the wound. You may need tests, such as an X-ray, MRI, CT scan and vascular studies to help create a treatment plan.
What treatments are available?
Cleveland Clinic has a specialized team of doctors, nurses and other medical specialists to help provide the best possible treatment for patients with leg and foot ulcers.
The goals of treatment are to relieve pain and heal the wound as quickly as possible. Your treatment plan will be based on your overall health, medical conditions and ability to care for the wound.
If the wound is infected, your treatment will include antibiotics.
Your doctor may also prescribe medication to prevent a blood clot.
Your treatment plan is based on the type of ulcer you have.
Treatment for patients with venous stasis ulcers
If you have a venous stasis ulcer, your treatment plan will include compression techniques to manage swelling. Your doctor may recommend compression stockings, multi-layer compression wraps, or wrapping your lower leg with an ACE bandage. The type of compression that is best for you depends on the characteristics of the ulcer and the amount of drainage you have.
You may also need to use a dressing to cover the ulcer. There are several types of dressings your doctor may recommend based on the type of ulcer you have and the appearance of the base of the ulcer. Dressings include:
- Moist to moist dressings.
- Hydrogels/hydrocolloids.
- Alginate dressings.
- Collagen wound dressings.
- Debriding agents.
- Antimicrobial dressings.
- Composite dressings.
- Synthetic skin substitutes.
Treatment for patients with neurotrophic (diabetic) ulcers
If you have a neurotrophic (diabetic) ulcer, your treatment plan will include keeping pressure and weight off the leg that has the ulcer. You will likely need to wear special shoes or use an orthotic device. Another part of treatment is removing infected tissue on a regular basis (debridement). This helps the healing process.
Treatment for patients with arterial (ischemic) ulcers
If you have an arterial ulcer, your treatment will be based on the extent of your arterial disease and overall condition. You may need to have vascular testing done to determine how well the ulcer may heal. It is possible you may need invasive testing, endovascular therapy or bypass surgery to restore blood flow to your leg.
The goals of treatment are to:
- Protection of the surface of the skin.
- Prevent new ulcers from forming.
- Prevent irritation of the ulcer.
- Watch for signs of infection that could spread to your body’s tissue or bone.
Wound care at home
An important part of your treatment is caring for your wound at home. Your doctor will give you instructions about how to take care of the area. Please make sure you understand exactly what you need to do and how to do it. Ask your doctor or nurse if you have any questions about wound care.
Wound care basics include:
- Keeping the wound clean and dry.
- Changing the dressing.
- Taking all medications as prescribed.
- Drinking plenty of fluids.
- Eating a healthy diet that includes plenty of fruits and vegetables and follow any special nutrition instructions you have.
- Regular exercise (check with your doctor about the types and amount of exercise you need).
- Wearing proper shoes and orthotics (if needed).
- Compression wraps (if needed).
What can I do to prevent leg and foot ulcers?
You can reduce your risk of leg and foot ulcers and keep ulcers from getting worse by following these steps:
- Don’t smoke. If you need help to quit smoking, talk to your doctor about ways to make this change easier.
- Control your blood pressure. If you are being treated for hypertension, follow your treatment plan.
- Control your cholesterol and triglyceride levels. You can control these levels by eating a heart-healthy diet and taking medications your doctor prescribes.
- Limit the amount of sodium in your diet.
- Follow your treatment plan for medical conditions you have, such as diabetes, and keep your follow-up appointments with your doctor.
- Get regular exercise. Talk to your doctor before starting any exercise program.
- Lose weight, if needed, and maintain a healthy weight.
- Ask your doctor about aspirin therapy to prevent blood clots.
Skin and foot care
Careful skin and foot care are part of every treatment plan for patients with leg or foot ulcers. Foot care includes daily checks for sores on your feet and skin. These are especially important if you have diabetes.
Washing: Gently wash the affected area on your leg and your feet every day with mild soap (Ivory Snow or Dreft) and lukewarm water. Washing helps loosen and remove dead skin and other debris or drainage from the ulcer. Gently and thoroughly dry your skin and feet. Do not rub! Make sure to dry the skin between your toes.
Daily checks: Take time every day to look at your legs, your feet (tops and bottoms) and the skin between your toes. Check for any blisters, cuts, cracks, scratches or other sores. Also check for redness, increased warmth, ingrown toenails, corns and calluses. Use a mirror or ask a family member to help you if you have trouble.
Moisturize: Once or twice a day, apply a lanolin-based cream to your legs and feet (tops and bottoms) to prevent dry skin and cracking. Do not apply lotion between your toes or on areas where there is an open sore or cut. Use the cream more often if your skin is extremely dry.
Toenail care: Keep your toenails trimmed and smooth. Cut them after bathing, when they are soft. Cut your toenails straight across and smooth them with a nail file. If you have diabetes, it is important to see a podiatrist on a regular basis.
If you have a corn, calluses or other foot problem: Go to a podiatrist. Do not treat the problem yourself. Do not wait to get treatment for a foot or skin problem, and follow your doctor’s guidelines for care.
