The skin is a barrier, designed to protect the body from attacks, infection and injury. A wound or ulcer is a break in the skin. There are several other words used to describe a break in the skin including cuts, scratches, abrasions, lacerations, sores and of course wounds and ulcers.
Many wounds are superficial and require only local first aid for them to heal. On the other hand, some wounds are deeper and need special medical attention to prevent infection and damage to underlying tissues like the bone or muscle, to help wounds heal and prevent complications. Ulcers can have many detrimental effects on the lives of persons with them. Ulcers are often painful, decrease the quality of life, especially if ulcers are chronic, they control your life in terms of what you can do and where you can go, they can smell and can be embarrassing. Here are some tips on what to do if you have a wound on the foot or lower leg.

What causes leg ulcers?
There are different types of wounds based on the size, depth and cause of the wound. Leg ulcers are much more common in people as they get older due to poor circulation in aging limbs. Two conditions that add to the complications of leg ulcers in the elderly are obesity and diabetes. Wounds or ulcers can be caused by pressure, damaged veins, poor blood flow, diabetes and as the result of trauma. People with sickle cell anaemia and other medical conditions may also be at high risk for developing leg ulcers.
There are many other causes of leg and foot ulcers including rheumatoid arthritis, hypertension, renal (kidney) failure, lymphedema, inflammatory diseases (Lupus), high cholesterol, heart disease, sickle cell anemia, bowel disorders, a history of smoking, trauma, burns and even some medications. Ulcers can also be associated with depressed or lowered immune systems and poor nutrition. Leg and foot ulcers can also get worse when they become infected with bacteria.

Symptoms
Regardless of the type of wound you have on your feet or legs, there are common symptoms seen in all ulcers and then there are symptoms that are specific for the type of ulcer you may have. With all ulcers there is a loss of some or all of the layers of the skin and the underlying subcutaneous tissue is exposed.
Venous ulcers are the most common leg ulcers accounting for more than 80 to 90 percent of all leg ulcers.
Years of research have shown that the usual cause of these leg ulcers is not a problem with the skin itself, but rather with blood not flowing properly through the veins under the skin. This is caused by high blood pressure in the veins. People with venous ulcers also experience leg pain and heaviness, swollen ankles, prominent veins and the ulcers are commonly located below the knee, on the inner part of the leg, just above the ankle. The skin around the ulcer darkens and can even become hard. Ulcers can be on one or both legs.
Diabetic foot ulcers are usually located on the bottom of the feet where there is increased pressure from changes in the shape of the foot and walking. Diabetics often lose the feeling in their feet and because they are unable to feel, they continue to walk on the foot causing more friction and pressure until eventually calluses and then an ulcer develops. Diabetic foot ulcers are often complicated by poor blood flow and infection and can result in amputations.
The blood supply to the feet is crucial. Ulcers can occur as a result of poor circulation to the feet. They can be very painful because of the limited blood supply. These ulcers usually occur between, or on the tips of the toes. The feet can be very cold or turn blue, black or gangrene.
Pressure ulcers are caused by prolonged pressure or friction to the feet -- especially on the heel of people who are confined to their beds and cannot change their position regularly. This pressure damages the skin and causes it to break down.

Care for wounds at home
Keeping a wound clean is the best way to avoid infection. Any superficial or shallow wound can be cleansed with mild soap and water while deeper wounds should be cleansed with saline. Often times people may tell you to leave the wound open to the air to help it heal faster, but this is incorrect. In fact, leaving the wound open to air will slow down its healing. Wounds heal best when they are moist and covered. After cleaning the wound, cover it with a clean gauze, tape or bandage. You can also put antibiotic cream or ointment on the wound before bandaging it.

When to see the doctor
Most wounds can be treated at home with routine first aid including thorough washing and dressing to prevent infection. Small, superficial wounds on young, healthy people can be treated at home and are expected to heal fairly quickly. For elderly people with chronic health conditions, having an ulcer or wound is a problem with potential for serious complications. This should motivate them to seek medical attention right away. Any diabetic with a wound should see the podiatrist right away. If you have poor circulation, venous problems or other medical conditions that contributed to the development of the wound, you also need to seek medical attention right away. If there is any sign of infection including redness, swelling, increased pain, odor and pus at the wound site, seek medical attention right away.

Diagnosing leg ulcers
Diagnosis is usually made based on symptoms, location and characteristics of the wound. It can be based on the patient's medical history and a physical examination by a wound specialist or podiatrist. Laboratory tests and imaging studies such as x-rays, MRIs (magnetic resonance imaging), CT (computed tomography) scans and non-invasive vascular studies may be ordered to help develop a treatment plan.

Treatments for leg ulcers
Successful treatment of foot and leg ulcers is directed toward correcting the cause of the ulcer and not just the ulcer itself. Once the causes of the ulcers are known and under control, (for example the blood sugar level or decreasing foot pressure in diabetes) the ulcer should progress toward healing by itself. Wounds heal at different rates based on the type of wound and the health of the person with the wound.
Other treatment strategies may involve cleaning the wound, wound dressings, reducing pressure, compression socks or stocking, etc. It may also involve weight loss if you are overweight and regular exercise to promote good circulation. For poor blood flow to the legs, a referral to a vascular specialist may be required. Medications may also be ordered to improve wound healing. Good blood supply and good nutrition is vital to ensure wound healing.
Having a non-healing ulcer for long periods of time can be very dangerous and can lead to infections and amputation of the foot or leg. If you have an ulcer on your leg or feet, you should see a podiatrist right away for proper evaluation and treatment.

o For more information, email me at foothealth242@gmail.com or visit www.emedicine.com or www.podiatrytoday.com. To see a podiatrist, visit Bahamas Foot Centre on Rosetta Street or call 325-2996 or Bahamas Surgical Associates on Albury Lane or call 394-5820 for an appointment.

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