Leg and Foot Ulcer
Chronic leg and foot ulcer also known as chronic lower limb ulcer is a chronic wound of the leg that shows no tendency to heal. The incidence of ulceration is rising as a result of the ageing population and increased risk factors for atherosclerotic occlusion such as smoking, obesity, and diabetes. Ulcers can be defined as wounds with a full thickness depth and a slow healing tendency. Leg ulcers are an important source of morbidity in our ageing population.
Around the world, leg ulcers are mainly caused by venous insufficiency, arterial insufficiency, neuropathy, diabetes, or a combination of several or all these factors. Venous ulcers are the most common type of leg ulcers, accounting for approximately 70% of cases. Arterial disease accounts for another 10% of leg 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 Heaviness, Large varicose veins, Pus, bleeding and discharge, Swelling and Change of color.
In people with these conditions, even a small foot ulcer can become infected if it does not heal quickly. If an infection occurs in an ulcer and is not treated right away, it can develop into:
- An abscess (a pocket of pus)
- A spreading infection of the skin and underlying fat (cellulitis)
- A bone infection (osteomyelitis)
- Gangrene. Gangrene is an area of dead, darkened body tissue caused by poor blood flow.
What are the types of leg ulcers?
In venous disease, ulcers are usually located in the gaiter area between the ankle and the calf, often on the medial aspect of the leg. Venous ulcers arise from venous valve incompetence. Valvular incompetence in the deep veins causes the vessels to become distended and stretch to accommodate the additional blood flow. The valves are not able to effectively close, which results in retrograde blood flow and venous hypertension. The venous hypertension, leads to leakage of fluid out of the stretched veins into the tissues, causing deposition of a brownish/red pigment in the gaiter area of the leg. Venous ulceration occurs in the gaiter area in 95% of cases especially around the malleolar (the rounded protuberance on the ankle) region.
Neuropathic ulcers commonly occur in the feet of patients with sensory loss, often caused by peripheral neuropathy. They are frequently found on the toes or metatarsal heads and may be preceded by formation of callus in areas of pressure. Pain is characteristically absent. Neuropathic ulcers frequently occur in the context of diabetes, and ulcers account for much of the morbidity associated with this illness. Diabetes can cause both neuropathy and ischemic disease; as a result, many ulcers have a multifactorial etiology. When a neuropathic ulcer is diagnosed, arterial blood flow, structural foot deformity, and clinical presence of infection should be assessed.
With neuropathy being the underlying cause of ulceration, many patients complain of burning, tingling, or numbness of the feet on presentation. The ulcer is usually on the plantar foot, most commonly under the great toe or first metatarsal head. Because of pressure, it is often surrounded by a rim of hyperkeratotic tissue, which may even cover the ulcer and give the illusion that the ulcer has healed, when it in fact has not. Infected ulcers may be associated with cellulitis, lymphangitis, adenopathy, calor, edema, foul odor, and purulent drainage.
Atherosclerosis is the most common cause of peripheral arterial occlusive disease. This predominantly affects the superficial femoral and popliteal vessels, reducing blood flow to the lower extremities. When the ischemia is severe enough, ulceration will develop.
Arterial ulcers are almost always painful. Patients may relate intermittent claudication, pain in the extremities or buttocks with activity that is relieved with rest. If occlusion is severe enough, there may be pain even at rest. A familiar complaint is pain in the legs when lying in bed at night that is relieved by dangling the legs off the side of the bed.
The skin may be shiny, smooth, cool, and demonstrate pallor or a reddish-blue discoloration. The ulcers have a predilection for the lateral aspect of the leg, posterior heel, distal aspects of the digits, medial aspect of the first metatarsal head, and lateral aspect of the fifth metatarsal. The ulcer itself will often have a dry, dark base of eschar.
In venous insufficiency, the valves of the veins deteriorate and allow blood to return, causing the blood to stagnate in the veins, increasing their size and producing varicose veins
Typical venous ulcer
Typical diabetic foot ulcer
So…How can wen help you?
Platelet Rich Plasma
The human blood contains red and white bloods cells, platelets and plasma. PRP refers to blood plasma that contains a large concentration of platelets. Platelets contain the necessary bioactive proteins and growth factors to repair and regenerate human tissue. PRP injections produce regeneration and repair of damaged tissues. At Regenecare Pain Clinic we obtain great results in tissue regeneration and chronic wound healing with our PRP protocol.
Platelet agglutination to repair damaged tissue
Ozone has multiple therapeutic effects on wound healing due to the property of releasing nascent oxygen, which has been shown to have bactericidal capabilities and to stimulate antioxidant enzymes. Likewise, ozone modifies the wound environment, having a bactericidal effect that limits infections and improves the chances of healing. Recurrent sessions of ozone therapy have shown magnificent results in the healing of chronic wounds of the legs and feet. At Regenecare, we offer a comprehensive treatment for the healing of the wounds of our patients, combining different therapeutic methods.
Ozone therapy for diabetic foot
Am I a good candidate for Regenerative Treatments?