Foot Wound

Wounds happen on our feet all the time. Some are painless, while others cause a great deal of pain. Most just heal on their own. But sometimes you might notice a foot wound that is not healing. Obviously, that can be a cause for concern. In fact, there are several types of foot wounds. Treatment can be very different depending on the cause. So making the correct diagnosis matters.

Foot Wound from Lack of Blood Flow

Our whole body needs constant blood flow to function properly. Significant lack of blood flow will jeopardize the integrity of our skin. Once this happens, any small injury will result in a skin break. The feet are a prime location for wounds from lack of blood flow. This is because of two main reasons. First, they are the farthest from the heart. This means, they will be affected by all the blockages on the way. And second, because it is hard to protect the feet from small injuries that happen in everyday life.

Practically, there are two main reasons for lack of blood flow. Either there are artery blockages, or the arteries spasm. In any case, these wounds hurt. While they can hurt throughout the day, they usually hurt the most at night. In fact, they are a real reason for lost sleep because of night leg pain.

Peripheral Artery Disease

The most common cause of artery blockages is peripheral artery disease, PAD. The cause for peripheral artery disease is atherosclerosis. This means that damage from smoking, high blood pressure and elevated cholesterol builds up over the years to cause blocked arteries.

Most people who have peripheral artery disease will actually not have any symptoms at all. Of the people who do have symptoms, the most common problem will be leg pain with walking. Wounds and ulcers will only happen in very advanced cases of peripheral artery disease. When this happens, we call it critical limb ischemia, CLI.

A foot wound from lack of blood flow will usually be on the tip of the toe, or on the heel. These wounds are usually very painful. Left untreated, wounds from lack of blood flow will deteriorate to gangrene.

Sometimes a person might have leg pain before a wound happens. This pain usually happens at night, when they put their feet up and there is less blood flow. The term we use to describe is pain is ‘rest pain’. You should never ignore rest pain. First, it is just painful. But also, because it means a foot ulcer is on the way.

Constricted Arteries

Sometimes blood does not reach the feet because the arteries constrict. Artery constriction can actually be a normal process. For instance, if you go out to the cold, your arteries will constrict to protect your fingers. But if the constriction is exaggerated, blood will not reach the toes, and the skin might break.

In the feet, the most typical location for a wound from constricted arteries are the toes. These wounds are usually painful. The other toes might seem pale or purple.

The most common cause for arteries to constrict is the cold. But sometimes, the narrowing is the result of a disease. Other times, the narrowed arteries are a result of a medication. A common medication that can cause arteries to narrow is Adderall. There is scientific evidence that some people who take Adderall or similar medications develop foot wounds. Some even lose toes as a result of the medication.

Neuropathic Foot Ulcer

Neuropathy means that the nerves are not functioning properly. Sometimes neuropathy causes neuropathy leg pain. But often people who suffer from neuropathy cannot sense their feet properly. By the way, a person might have both pain and lack of sensation.

Once lack of sensation is present, a minor injury can grow quickly into a foot ulcer. But that is not the end of the problem. Because once a wound develops, it is important to stop putting pressure on the wound and treat it quickly. But neuropathy means that there may be a delay in this as well. A patient with neuropathy just won’t know that they have a problem that needs treating.

A neuropathic foot wound will have the following characteristics:

• The location is over pressure points. For this reason, it is often of the sole of the foot, over bony bulges
• These wounds are often deep
• Despite being deep, there is usually no pain at all
• A raised callus will surround it
• The inside of the wound can be pale if there is also lack of blood flow. But it can also be red, if there is normal blood flow

A neuropathic foot ulcer might get infected. Because these wounds are deep, and because pain is absent, infection can set into the bones before anyone even notices.

Venous Leg Wound

If you have a foot wound, the reason is probably not a venous ulcer. In fact, wounds from vein disease do not typically appear on the feet. A more typical location for them would be the inner side of the ankles. Still, these wounds are worth mentioning, if only because they are so common.

Diabetic Ulcer

Diabetics have a tendency for foot wounds. This has several reasons. First, many diabetics suffer from peripheral neuropathy. Practically, they may not feel their feet properly, and this leads to injury. Neuropathy also means that once a wound develops, a diabetic may not know that it is there, because they will not feel the pain. In some cases, patients will continue to step on a wound, making it worse, just because they did not even know it was there.

Next, diabetics often suffer from problems with artery blood flow to the feet. They will typically have artery blockages below the knee, in the small arteries of the calf. Sometimes, they will have hardening of the arteries. All this makes the blockages harder to treat.

Finally, diabetics have poor wound healing. For a wound to heal, the body needs to get the appropriate nutrients and cells to the area. In diabetes, there are several problems with this mechanism. First, there are the problems with blood flow that I already mentioned. But also, there are multiple abnormalities with how various cells function. These abnormalities prevent proper wound healing from occurring.

The term ‘diabetic ulcer’ is the combination of all these causes. In fact, a person with diabetes may have a classic foot wound from lack of blood flow, or a typical neuropathic ulcer. But often, their wounds will result from a combination of these causes.

Cancer Foot Wound

Always suspect cancer in a foot wound that does not resolve in a reasonable amount of time with reasonable treatment. Never ignore such a wound. Always obtain a biopsy to make sure cancer is not hiding in the wound.

Weird Foot Wounds

Sometimes, a wound will not fall into any one of the neat categories. In these cases, there are two options. The first, is that the wound is the result of a combination of causes. Just like a diabetic wound. But there is a second option. It could be that the wound is just the result of an unusual cause.

One unusual cause is vasculitis. This is when there is unwanted inflammation in the body and usually the body also attacks itself. Sometimes wounds will be a sign that the inflammation is not under control or that the condition is advanced. If you suspect vasculitis it makes sense to involve a rheumatologist who is an expert in these conditions.

A second unusual cause is bug bites. Some people will have foot wounds because of scabies, for instance. Certain spider bites can cause wounds. True, the feet are not the most typical location for some of these, but anything can happen.

A third example is exposure to the elements. Long exposure to wetness or to cold can damage the skin. For instance trench foot or frostbite. People will usually know what happened, and getting them into a warm, dry, place is the first step of stopping the process.

One last example of an unusual cause would be a condition called pernio or chilblains. In this condition, a person might have foot ulcers during the cold season that disappear once the weather improves. A dermatologist or vascular medicine doctor will usually make the diagnosis. The only effective treatment is to avoid the cold.

Foot Wound Treatment

The treatment of a foot wound is complicated. It usually takes a team of specialists to get these wounds to close. If you have a wound over your foot, finding your way to a proper wound care center can make the difference between healing and complications.

The chances of a foot wound to close depend on a few standard factors. These include the cause for the wound, the wound size and depth, and the presence of infection. There is even a scale that helps us decide if a wound will likely close or not called the WIfI classification.

In any case, there are a few guiding principals in getting these wounds to close. These include offloading, treating infection, dressing the would properly and improving blood flow when that is a problem.

Offloading

To offload a wounds means to take pressure off it. In real life, this is not always simple to do. A person needs to get around. But there are special tools that help us. For instance, there are special offloading boots and scooters that can help us move around, while keeping the pressure off the wound. A podiatrist, foot doctor, will usually be part of a proper wound care team. Part of their job will be to help keep pressure off wounds.

Infection Control

Healing cannot happen properly if infection is present. So identifying infection and treating it are important. Once we identify infection, treatment will have two parts. First, cleaning out the wound. Sometimes, if the infection is deep, that will require a surgical procedure. Once the wound is clean enough, adding antibiotics can make sense.

Dressing

How to dress a wound properly is as much an art as it is a science. There are so many products out there and knowing what to choose and when is not easy. A wound needs a slightly moist, and clean environment to heal. Sometimes, special medications in the dressing promote wound healing even more.

Improve Blood Flow

A wound will not heal without proper blood flow. The blood flow is necessary to bring enough nutrients to the wound to allow the healing process to happen. By the way, blood flow is also important to get medication such as antibiotics to the wound.

Improving blood flow to a wound will require a procedure. The procedure can be done with catheters, balloons and stents or with open surgery. Which procedure is the best for you depends as much on the ulcer and your arteries, as it does on your doctor’s expertise.

Prevent Recurrence

Once a wound has healed, keeping it closed is as important as it was to get it to close in the first place. There is no magic here. To prevent wounds from recurring you have to get into good habits. You should start by inspecting your feet and addressing any small new problems before they blow-up. Of course, you should keep your feet clean. Avoid injury. This means common sense things like having someone else trim your toenails. Don’t walk barefoot, so you don’t step on something sharp. If you follow these simple measures, chances are you will have a lower chance of having another foot wound to deal with.

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