A foot ulcer is lesion, wound or break in the skin and soft tissue on your foot that may possibly, in some cases take longer to heal.
• Poor circulation (Peripheral Vascular Disease)
• Loss of sensation (peripheral Neuropathy
• Foot deformities due to arthritis and other conditions, leading to high pressure areas on foot/feet
• Gait abnormalities
• Poorly fitting footwear
These factors may impact/reduce the skins ability to react to fluctuations in pressure on the foot during gait, increasing risk of trauma or damage to skin and risk of ulceration.
Remove source of the problem, for example pressure reduction may help fragile skin to heal. YThis can be achieved by resting the foot as much as possible, using pressure relieving padding or insoles, orthopaedic footwear. For some patient a total contact cast or other pressure relieving devices may be better suited. Your Podiatrist will discuss and advise you on treatment options.
There are a number of things a podiatrist may do in the treatment of a foot ulcer, provided they are appropriate for the presenting wound. These may include:
• The removal of callus and non-viable tissue which surrounds the wound using a scalpel blade, termed sharp debridement. It is important that any non-viable tissue is removed as this can be detrimental to the wound healing and if not removed it may lead to the deterioration of the wound. Please be aware that a wound can look bigger after treatment and bleeding often occur. Sharp debridement should not be attempted by any patient.
• Pressure relief, such as padding, insoles or specialist footwear
• Wound swabbing or tissue samples to test for infection
•Antibiotic treatment in the presence of infection. Antibiotics may be changes to a different one pending swab or tissue sample laboratory results.
• X-rays, bone scans or other imaging investigations.
• Vascular assessment and intervention to improve blood circulation if necessary
Podiatrists are located a various clinics in the community where the diagnosis, management and treatment of ulcerations can be achieved. On your first appointment (assessment) the podiatrist will be able to determine the cause of your foot ulcer and develop the most appropriate care plan for you. The sensation and circulation on your feet will be assessed. A photographic image of the ulcer may be taken at every appointment so its size can be compared/ assessed/ monitored. You will be advised on your current/most appropriate footwear needs. All podiatrist working for East Coast Community Healthcare are wound care specialists so you may not see the same person at each visit. This is also beneficial for your care as it gives you more options with regards to appointments and locations where you can be seen. There are regular case conferences within the team and other healthcare professionals to manage your case which will be discussed fully with you.
For non-healing wounds, osteomyelitis (bone infection) or Charcot foot (see Charcot foot leaflet) you may be referred to the MDfT. This highly specialist foot team includes a Vascular Surgeon, Foot and Ankle Surgeon, Consultant Endocrinologist, Musculoskeletal Specialist, Podiatrists and a Podiatry Assistant. We are hoping to include a Microbiologist and a Orthotist to the team in the future. The clinic is based at the James Paget University Hospital.
If you notice a problem with your feet please don’t ignore it, seek advice straight away. The signs that should cause concern and may be an indication of infection are:
• Any new ulcers or blistered areas on your feet
• Your foot becoming noticeably hotter than normal
• Any colour change; red or blue or bruising
• Any new areas of swelling on your feet
• Any discharge coming through the dressing where previously it was dry
• Any new pain or throbbing sensation
• Your foot developing an unpleasant odour
• Feeling feverish or unwell may also indicate the presence of infection.
If you have any foot health concerns and think this may potentially lead to a complication then please consider discussing a podiatry referral with your GP.
If your foot becomes red, hot or swollen, with new pain, with or without a wound please ask your GP to refer you to Podiatry.