An ulcer occurs when impaired circulation or pressure causes damage to tissue, resulting in a sloughing of the skin and sometimes the underlying tissue (fat, muscle) as well. While ulcers can occur anywhere on the body, especially over bony prominences (such as the hip bones and the coccygeal area of the lower back), the legs are common sites for venous, arterial, neuropathic and pressure ulcers.
Venous Ulcers
Venous insufficiency occurs when the veins that carry blood back to the heart to pick up oxygen are impaired, causing fluid to pool in the tissues. This results in edema (swelling), which interferes with circulation. As blood cells seep from the vessels into the tissues, the front of your lower leg above the ankle may develop a brownish discoloration (hemosiderin staining), and deposits of protein and fibrin in the tissues causes the skin to harden and take on a waxy appearance. The skin of your lower leg may become inflamed with red, scaly, weepy or itchy skin. Ulcers are usually irregular shaped and occur on the front of the lower leg or over the ankles. Pain may be mild to severe.
Arterial Ulcers
Peripheral arterial disease, usually coming from buildup of plaque in the arteries, can cause circulatory impairment and blockage of the vessels. This impairs oxygenation of the tissues and can cause necrosis (death) of the tissue, resulting in an ulcer. Ulcers are usually very painful, round and deep and occur most often on the ends of the toes, between the toes, on the heels or over pressure areas (such as where clothing or shoes rub against the skin). The skin on your leg and foot may lose hair and appear shiny and pale. The foot may also appear bluish-purple or red because of lack of oxygen.
Neuropathic/Diabetic Ulcers
Neuropathy, common with diabetes, causes decreased sensation in the leg and foot. Coupled with impaired circulation, this puts you at risk for undetected injury. A neuropathic/diabetic ulcer usually begin as a small cut or blister that becomes inflamed, causing necrosis. Ulcers are most common on the foot, especially the toes, bunion area and heel. Ulcers are usually round with well-defined edges, surrounded by a ring of hardened tissue (callus).
Pressure Ulcers
Pressure ulcers are most common in the elderly and those with spinal cord injuries. If you are not able to shift weight, the pressure from lying or sitting in one position can cut off the oxygen supply to the tissue, causing damage. Ulcers are common over bony prominences, such as the hips, ankles and heels, and can occur beneath the knees (from sitting in a wheelchair) or on the sides of the knees. Pressure ulcers may range from red, dusky (bluish-black) discoloration of skin, to blistering, to sloughing of tissue and to necrosis with thick black dead tissue (eschar) covering the ulcerated area.
Prevention/Solution
Prevention is the key to managing leg ulcers. Depending on the cause, this can include modifying diet, elevating legs, wearing compression stockings, and controlling swelling with medications. You should check your skin daily, moisturize and avoid wearing ill-fitting shoes or going barefoot.
Tags: Ulcers usually, bony prominences, bony prominences such, impaired circulation, most common