Never ignore a Leg Ulcer : It may cause loss of your foot

Dr. K.K. Pandey *

A 63-year-old female with diabetes and rheumatoid arthritis presented with a chronic venous ulceration (2 cm X 2.6 cm) to the dorsal aspect of the right leg. The wound had been present for over two months despite application of compression therapy and topical agents.
Pix - wikipedia/Jonathan Moore

Many a times, an injury or a simple scratching on the leg result into a long-standing leg ulcer and if not treated adequately may result into a situation, where you have no option left except losing the leg. It is a common notion among general public that leg ulcer is generally caused by an eczema or a skin disease, therefore patients of leg ulcers more often either go to a skin specialist or a homeopath for treatment.

Some of these patients consult a general surgeon too, where a continuous process of daily dressings, and minor surgical cleanings goes on for months. All sorts of antibiotics are tried; even then leg ulcer refuses to heal. Some of these patients even go to quacks practicing ancient medicines and get treated for years. It has been observed all sorts of these treatments ultimately fail and result into a loss of foot.

What causes leg ulcers?

Many people, including even educated ones in our African continent, are not aware of the fact that the leg and foot ulcers, which do not heal over a period of time, are caused by diseases of veins in almost 75 percent of cases. Veins in our body form a drainage system of all the four limbs and other organs of the body. Veins collect impure blood, deficient in oxygen from all the organs of the body and carry it back to heart and lung for purification and thus keep on replenishing the blood with oxygen.

If this drainage system of veins becomes defective due to any reason, a large portion of the impure blood starts collecting into the legs, and this leads to undue backpressure on the veins of lower limbs. If timely intervention is not initiated, it may lead to ulcers on your legs & feet. These ulcers are called venous ulcers , and diseases of veins are responsible for these ulcers. Among the disease of veins, chronic venous insufficiency (CVI) tops the list.

The second most common cause of leg & foot ulcer is the disease of arteries. In fact, it is only artery which carries oxygen – enriched pure blood from our heart to various organs of body including our limbs. About in 20 percent cases of leg or foot ulcers, arterial disease is mainly responsible. Disease of the artery leads to narrowing of its diameter and this result into decreased supply of pure blood and hence less oxygen supply to various organs including legs in our body.

In such a scenario, where leg is already deficient in oxygen, a simple injury in leg may lead to dangerous complications. Apparently, a simple looking ulcer will not heal despite antibiotics and medical management and gradually over a period of time, will develop into a large ulcer with complications and ultimately result into amputation of foot or leg.

In 5% cases of leg and foot ulcers, the diabetes is the culprit, the third most common cause after venous and arterial disease. There is decreased sensitivity in diabetic patients and hence, very less perception of pain due to leg and foot ulcer. Because of this precise reason, diabetic patients tend to become less aware of their injury and ulcer on their leg and foot. Hence they became careless in management and their ulcer assumes dangerous proportions.

Besides this, in diabetic patients, by and large, diseases of arteries are known to co – exist. This further jeopardizes the oxygen supply of legs to a dangerously - low level, and will result into a non- healing ulcer and gangrene of the foot.

Blood pressure, obesity, fire burn, disease of joints like rheumatoid arthritis, anemia and infection do play an important role in the development of leg and foot ulcers.

Where to go, if you have leg ulcers?

If your leg and foot ulcer do not heal completely within a period of 2-3 weeks, immediately consult a Vascular Surgeon instead of a General Surgeon or a Plastic Surgeon. The patients must visit a hospital where active and full - time services of a Vascular Surgeon are available. Patients must ensure before entering a hospital whether the hospital is equipped with necessary and relevant investigatory facilities like Angiography, Venography, Nuclear Medicine, Doppler Study and M.R.I. Such patients should prefer hospitals, which provide facilities like hyperbaric oxygen therapy and where arterial & venous bypass surgical facilities including artificial grafts are available.

What to do if you have non - healing leg ulcer?

1. Consult immediately a Vascular Surgeon.
2. Reduce your weight. Excess weight delays healing. The process of carrying deoxygenated blood from legs back to heart gets slowed down.
3. Avoid cold exposure. It is very essential to keep your legs and feet warm. Room must be warm and comfortable
4. Avoid any ointment and cream, because of risk of developing eczemas over the skin surrounding the ulcer. This may hamper the healing process. There should not be any moisture over the leg and foot having ulcers.
5. Daily cleaning of wound is essential. Leg and foot should be soaked daily, for half an hour in potassium permagnate solution before cleaning and dressing
6. Daily exercise of legs and foot is of utmost importance. Leg ulcers are difficult to heal in a patient who remains confined to bed.
7. Avoid high-heeled sandals, shoes and chappals. Shoes must be very soft and comfortable. Tight shoes do more harm than good to legs and feet. Avoid walking bare – footed even inside the house. It is desirable to wear soft shoes while at home.
8. Never apply tight dressing or bandage over the legs & foot. Bandage or dressing if wrongly applied will be harmful to leg ulcer, and even may cause dangerous complications.
9. Keep your legs elevated during night times in bed. Put one or two pillows underneath your legs.