Surgery

Foot and Leg Wounds and Ulcers

If you have an open sore on your foot or leg that won’t heal, you may be experiencing a foot or leg wound or ulcer linked to poor circulation or neuropathy. At Mount Sinai, we can treat foot and leg wounds and ulcers with excellent results.

About Foot and Leg Wounds and Ulcers

Most of the time, leg ulcers cause pain. If, however, you get leg ulcers due to nerve problems (as with uncontrolled diabetes), you may not feel any pain. And because there is no pain, people tend to ignore the ulcer, which can lead to a leg infection.

In addition to non-healing wounds and pain, you may also have these symptoms in your legs:

  • Heaviness
  • Large varicose veins
  • Pus, bleeding, and discharge
  • Swelling
  • Change of color

There are several types of foot and leg wounds and ulcers.

  • Venous ulcers are the most common type of foot and leg wounds and ulcers. They usually affect people with varicose veins or deep vein clots. They usually affect the inner part of the leg, above the ankle and may be irregularly shaped, reddish, and covered with yellow fibrous tissue. They also might have discharge.
  • Arterial ulcers affect people who have poor circulation, high blood pressure, diabetes, or are smokers. These ulcers usually appear on the outer part of the leg and on the heels, tips of toes, and between the toes where the toes rub against each another. These ulcers vary in color and do not bleed. Often, patients report decreased pain after they dangle their feet over the edge of the bed.
  • Neurotrophic ulcers/diabetic ulcers affect people who are diabetic, have nerve problems in their feet, or have had some sort of trauma to their legs or feet. These ulcers usually appear on the heels at the pressure points and may bleed. The surrounding skin is typically calloused.

Your chances of developing foot and leg wounds and ulcers are greatly increased if you smoke, are older, or if your parents had ulcers.  Other risk factors for ulcers are:

Diagnosis and Treatment

At Mount Sinai, we diagnose foot/ leg wounds and ulcers based on a physical examination and your risk factors. We may also use these imaging tests to collect information: 

  • Ankle brachial index test involves measuring blood pressure in the arm and leg, using high-frequency sound, and comparing the two together.
  • Arterial doppler is a type of ultrasound that helps us see any decrease in blood flow in the arteries and veins.
  • Venous Doppler is another type of ultrasound, which shows if there is any leakage in your veins or varicose veins.
  • Computed tomography scans (CT scan) help us see the blood vessels in the legs as well as the ulcer itself, using detailed cross-sectional images of the vessels.
  • Magnetic resonance imaging (MRI) uses radio waves to create a detailed picture of the affected area and to see if infection involves the bone and deeper tissue.

Our goal for treatment is to relieve pain and prevent infection or wound spread. You can make a few changes to your lifestyle that will help foot and leg wounds and ulcers:

  • Avoid standing for long periods of time
  • Drink more water
  • Eat more produce
  • Have regular feet checks and podiatry care (if you have diabetes or smoke)
  • Perform regular, moderate-intensity exercise
  • Raise your legs at night
  • Wear good walking shoes

At Mount Sinai, we typically treat these conditions with compression stockings or ACE bandages; unna boots; transparent, alginate, collagen, antimicrobial, or hydrocolloid dressings; and pain-relief medication. Special shoes or orthotic devices can also help.

Our expert surgeons can provide additional treatments, which vary by the cause of the ulcer or wound. Here are some of the most common approaches:

  • Venous ulcers. We use laser ablation to remove the superficial veins at the ulcer area. We can also use radiofrequency ablation, which uses electrical current produced by radio wave to decrease pain.
  • Arterial ulcers. We open the area where you have poor circulation and increase the blood supply to the area using catheter therapy or surgery.
  • Neurotropic ulcers. We can remove the dead, damaged, or infected tissue and provide antibiotics and special dressing to promote healing

Prevention

To prevent foot/ leg wounds and ulcers, we recommend:

  • Healthy eating
  • Exercise regularly
  • Lose weight
  • Regular screening for poor circulation and leaky veins if you have the major risk factors such as high blood pressure, diabetes, and obesity
  • Stop smoking
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