A foot ulcer or leg ulcer (ulcus cruris) is chronic skin damage to the lower leg, ankle or foot, usually due to disorders of the arterial or venous blood system. With increasing age, the risk for foot or leg ulcers increases significantly.
What is a foot ulcer and leg ulcer?
Foot ulcer or leg ulcer (ulcus cruris) refers to chronic skin defects on the lower leg and foot that extend at least into the dermis. In the majority of cases (about 85%), a leg ulcer is venous in origin (venous leg ulcer), that is, due to impairment of venous circulation such as varices (varicose veins). A venous leg ulcer occurs preferentially on the inner ankle and medial lower leg and may extend to the fascia (covering of connective tissue) or the underlying boil. In rarer cases, foot or leg ulcers are caused by an insufficiency of the arterial blood circulation (ulcus cruris arteriosum) due to narrowed leg arteries (pAVK, smoker’s leg). A leg ulcer is usually localized to pressure points such as heels or toes and manifests as cool, pale skin with possible livid (bluish) discoloration.
Causes
The majority of foot or leg ulcers are caused by chronic venous insufficiency (CVI), which is often due to so-called varices (varicose veins or dilations of the veins). Varicose veins, which are usually genetically predisposed to form, impair the closing function of the venous valves. As a result, edema (water retention) forms and, in the further course, the connective tissue hardens (sclerosis). Edema and sclerosis cause an undersupply of oxygen and nutrients to the surrounding tissue structures, especially in the ankle and medial lower leg (front) areas, which can lead to foot or leg ulcers. In addition to varicose veins, thrombosis (blood clots) in the deeper leg veins can cause chronic venous insufficiency and thus foot or leg ulcers. The less common arterial foot and leg ulcers can be caused by arteriosclerosis (calcification of the arteries). Diabetes mellitus, nicotine use, hypertension (high blood pressure), and hyperlipidemia (high blood fat) are risk factors for arteriosclerosis in the legs and, correspondingly, for foot and leg ulcers.
Symptoms, complaints, and signs
Leg ulcer is characterized by ulcers on the legs and feet. It can be venous or arterial in origin. The symptoms of the two forms of the condition differ somewhat. In the case of venous leg ulcers, blood can no longer be adequately transported to the heart due to weakness of the veins. Swelling (edema) occurs in the area of the legs. Due to the undersupply of nutrients to the tissue there, wounds develop that are difficult to heal and constantly ooze. The leaking fluid softens the tissue at the wound edges and, if not treated properly, is often contaminated with bacteria. The degradation processes caused by bacteria lead to inflammation and foul-smelling degradation products. Starting at the ankles, a venous leg ulcer often winds around the legs with enlargement, taking the form of a galoshes. Pain rarely occurs. However, venous leg ulcer is characterized by a constant feeling of tightness in the affected limbs. An arterial ulcer is mainly located in the area of the feet. In contrast to venous leg ulcers, however, severe pain occurs here. This is especially true when the feet are elevated or during movement. Furthermore, in arterial leg ulcers, necrosis of the undersupplied tissue can occur with blackening. Both forms of leg ulcers require a very long treatment period. However, the chances of healing are better in venous leg ulcers than in the arterial form.
Diagnosis and course
Foot and leg ulcers can usually be diagnosed by the characteristic skin changes in the affected areas. A special ultrasound examination (Doppler sonography) provides information on possible arterial and venous circulatory disorders, while a phlebography (X-ray with contrast medium) makes thromboses visible. A determination of blood glucose levels provides information about the presence of diabetes mellitus.If there is evidence of infection, the pathogens are detected by means of a smear. A spinalioma (squamous cell carcinoma) can be identified as the cause of a leg ulcer by means of a biopsy. As a rule, leg ulcers, especially venous leg ulcers, have a good course and heal within a few months, depending on the general health of the affected person.
Complications
In this disease, there are significant complications and discomforts that can lead to disorders and limitations in the feet and legs. In most cases, this can cause a very unpleasant odor in the affected regions and sores that become wet. In the legs feet also appear strong pains, which lead to movement restrictions. The pain can also occur in the form of pain at rest, leading to sleep problems and general irritability of the patient. In the further course, the skin turns bluish and the feet become cold, since the blood circulation can no longer be regulated properly. The patient’s quality of life is considerably reduced by the disease. Due to the constant pain and restriction of movement, it is not uncommon for patients to suffer from depression and other psychological upsets. Treatment is always causal and depends on the underlying disease responsible for the ulcer. Often there is a positive course of the disease without complications, but in some cases surgical intervention is necessary to resolve the symptoms. The patient’s life expectancy remains unchanged.
When should one go to the doctor?
If unusual swelling of the feet or legs occurs, a doctor should be consulted. Clarification of the cause becomes necessary if there is any impairment of locomotion or if the body becomes lopsided. If the existing footwear no longer fits or gait unsteadiness occurs, there is cause for concern. A feeling of pressure in the leg, sensory disturbances or a feeling of numbness on the skin should be presented to a doctor. Changes in the appearance of the skin and discoloration of the skin are considered signs of existing diseases. These should be examined and treated. If everyday tasks can no longer be performed and participation in sports activities or usual leisure activities is no longer possible, a medical check-up is necessary. If the symptoms increase or the ulcers spread further, a doctor should be consulted immediately. If circulatory problems occur, extremities become severely cold or warm, and the frequency of movements is restricted. A doctor should be consulted. In case of emotional problems, behavioral abnormalities or an increase in weight, it is also advisable to discuss the observations with a physician. Changes in self-smell as well as open sores on feet and legs should be examined and treated. If pain in the legs persists for several days, clarification of the symptoms is necessary.
Treatment and therapy
Therapeutic measures for foot and leg ulcers are aimed primarily at eliminating the underlying causes. Thus, venous leg ulcers are treated by improving the disturbed blood return by using compression bandages. In addition, leg ulcers should be treated with fibrinolytic ointments and/or antiseptic wound dressings to cleanse the wound. As part of a surgical procedure, the varicose veins converging on the leg ulcer can be removed or sclerosed (sclerotherapy) to improve blood flow. For poorly healing venous foot and leg ulcers, cell growth-promoting drugs are often used to accelerate wound healing. In addition, electrotherapy with direct current, as well as laser therapy with a focused electromagnetic light beam, promote cell growth and wound healing. If a bacterial infection is present in addition to the leg ulcer, antibiotic therapy is usually recommended. In many cases, a leg ulcer is accompanied by allergic contact dermatitis, which is treated locally with cortisone. In addition, fly larvae, which feed on the dead tissue, can be used for bio-enzymatic wound cleansing.Furthermore, bypass surgery, in which the disturbed section of the blood vessel is bridged using a natural or artificial piece of vein or artery to eliminate the circulatory disturbance, may be indicated for leg ulcers.
Prevention
Foot and leg ulcers can be prevented by measures that stimulate circulation, such as regular exercise, especially of the feet and legs while working at a computer. In addition, abstaining from or limiting nicotine consumption reduces the risk of vascular disease. Any existing excess weight should also be reduced to prevent foot and leg ulcers.
Aftercare
In the case of leg ulcer disease, aftercare measures are usually very limited. First of all, this requires complete removal of the ulcer to prevent it from spreading further. For this reason, above all, a very early diagnosis is necessary to prevent further complications and, in the worst case, the appearance of a tumor. Therefore, the ulcus cruris should be examined and treated by a physician already at the first symptoms. In most cases, those affected by leg ulcers require surgical intervention. In this case, bed rest should be observed for several days after the operation in order not to put unnecessary strain on the body. The legs and feet in particular should be immobilized and not subjected to unnecessary stress so as not to slow down wound healing. Wearing compression stockings can also alleviate the symptoms of leg ulcers. These should be worn regularly. In some cases, physiotherapy measures are also necessary to restore the movement of the affected person. Some exercises can also be performed by the patient at home. Whether leg ulcers lead to decreased life expectancy cannot be universally predicted.
Here’s what you can do yourself
Foot ulcers and leg ulcers must be treated professionally by a physician to prevent progression and complications. Supportive compresses with diluted calendula extract or arnica tincture can promote healing, and in some cases treatment with medicinal honey can lead to success. During the healing phase, the affected leg should be elevated as often as possible. Exercise is nevertheless extremely important to stimulate circulation. This applies both during treatment and after the ulcer has healed to prevent a relapse. In particular, prolonged sitting and standing inhibits the unimpeded blood flow in the legs, so regular breaks in movement and changes of position are advisable. Great importance should be attached to comfortable, non-restrictive footwear; rest periods can be used to elevate the legs. Hot tub baths and prolonged sunbathing are not beneficial for the health of the leg veins, while cold showers stimulate blood circulation. Continuing the compression therapy prescribed by your doctor can significantly reduce the risk of recurrence – it is also important to eliminate risk factors such as obesity and smoking. Improper foot care often leads to minor injuries that develop into leg ulcers. Diabetics in particular should therefore give priority to professional medical foot care and also ensure that their blood sugar levels are well controlled. Medical care of small wounds can often prevent the development of an ulcer.
