We here at Harvard Foot & Ankle specialize in diabetic limb salvage and the management of lower extremity ulcerations.  These can be particularly challenging cases, but our group of podiatric surgeons are dedicated to healing these wounds, preserving your ability to walk, and improving your quality-of-life.

Ulcers are open sores in the skin that occur when the outer layers of skin are injured and the deeper tissue is exposed.  This can be caused by acute trauma or chronic pressure of a particular area of the foot or leg.  

Causes

  • Bony prominences  
  • Ill-fitting shoe gear
  • Extended pressure while lying in bed 
  • Trauma 

Patients with uncontrolled diabetes, progressive neuropathy, or worsening vascular disease are more prone to development of these wounds and are at risk for developing infection of the skin and underlying bone.

Clinical evaluation 

Ulcerations are examined for the presence or absence of: drainage, odor, redness, inflammation, size, exposed bone.  X-rays are typically obtained to view a patient’s foot structure and evaluate for the possibility of bone involvement.  Other advanced imaging studies may also be necessary to evaluate for vascular disease, infection of the bone, or the patient’s ability to heal the wound.

Ulcer Management

  • Debridement, or the excision of any unhealthy tissue, is routinely performed to allow for proper healing and prevent infection.
  • Wound care products or medications are applied to keep the ulcer clean and promote faster closure.
  • Offloading is considered if increased pressure from weightbearing is keeping the ulceration from healing.
  • Compression therapy can help treat ulcerations with increased drainage or in patients with increased lower extremity swelling.
  • Slow to heal wounds may also be biopsied for the evaluation of possible skin cancer which may need to be treated.
  • If there is concern for infection, antibiotics may be prescribed, or if more serious, the patient may be referred to the local emergency department for more urgent management.
  • Consultation with other medical specialties may also be necessary to treat other comorbidities that are preventing your ability to heal.

Is surgery necessary?

Ulcerations may require surgical debridement and/or amputation if there is infection that has the potential to become limb threatening or life-threatening.

Elective surgery is also considered to decrease pressure to a particular ulcerated area or to excise an ulcer completely.