An ulceration is a break in the skin that is associated with loss of tissue on the surface. Ulcers are classified based on the depth or cause of the ulceration. Most ulcerations are caused by Diabetes, poor circulation or ischemia, or varicose veins. Diabetic ulcerations are the most common type of ulcerations of the feet. They occur on areas of the foot that are exposed to forces or irritations from the rubbing of the shoes on the skin. Corns and calluses form on the pressure areas of the foot. Over time the corns and calluses break down the skin creating the open areas or ulcerations. Individuals with diabetes and neuropathy are at the highest risk of getting ulcerations. Neuropathy is a condition in which the nerves are affected resulting in a loss of feeling in the feet. When a person with neuropathy has a corn or callus, which would normally be painful, does not feel pain and if not treated breaks the skin down resulting in ulceration. With the ulceration an infection will also occur which could reach the bone. Resulting in a bone infection or osteomyelitis. An individual with poor circulation has a difficult time healing an ulceration, which could result in gangrene. Ulcers have a tendency to reoccur in the elderly and may require years of therapy.
The treatment for ulceration involves primarily prevention and depends on the factors that cause the ulcer or have prevented the healing of the ulcer. Wearing the proper shoe wear that support the arches and has plenty of room in the toe box for the toes helps to reduce the pressures on the feet. Reducing the pressures reduces the chances for ulcerations to develop. Treatments are vascular stocking, unna boots, medications, elevation of feet, inserts, custom orthotics, and wound care. When the ulceration occurs, the ulceration should be cleaned and topical medications should be applied daily until the wound is healed. For deep ulcerations surgical debridement may be required in the office or operating room.