Non-healing foot ulcers have a 5-year mortality rate of approximately 48%. This means that someone with a foot ulcer that does not heal in a timely fashion, has a roughly 50% chance of being dead within 5 years. PAD (peripheral arterial disease) has a 64% rate. In comparison, breast cancer and Hodgkins lymphoma have approximately 12% mortality rates, prostate cancer 6% after 5 years. Lung cancer and pancreatic cancer are the only conditions with higher attributable 5-year mortality rates. 1
Prevention is always preferred and easier than treating a condition. Simple, daily self-examination is the best way to prevent formation of a foot ulcer but knowing risk factors and what to look for is critical.
Any person who has had a prior history of a foot or leg ulcer that did not heal in a timely fashion, or required professional medical treatment is automatically at a higher risk for developing an ulcer. Recurrence of ulcers in the same location of the leg or foot is quite common and prevention of such recurrence can be challenging and often requires continued monitoring and proactive management.
Persons afflicted with neuropathy, a condition of that affects the nervous system, may experience a range of symptoms in the lower extremities as well as the hands including, burning, numbness, tingling, shooting pain, or a loss of sensation. The inability to feel hot or cold sensation, sharp objects, minor trauma such as blister formation or cuts can lead to the formation of serious and limb threatening ulcers. While neuropathy is common among many persons with diabetes, there are other underlying causes. Anyone with neuropathy should inspect their feet closely, at least twice daily (prior to getting dressed and before bed) to ensure no injuries or ulcers are forming.
The presence of dry or scaling skin may lead to small microscopic tears or injuries in the skin that can allow bacteria to enter the body. Skin infections are quite common, especially in persons with chronic conditions such as diabetes or peripheral vascular disease (the name of the circulatory condition that affects both the arteries and veins) and may lead to more complicated wound formation. A decrease in or absence of hair on the toes, feet and legs as well as thickening of toenails may be signs of decreased blood flow over time.
Calluses on the bottom of the feet and contracted toes (hammertoes) create pressure points that can lead to among issues, reduced blood flow to the skin and may be precursors to future ulcer formation.
Changes in the temperature of one foot in comparison to the opposite foot may indicate impending ulcer formation on the bottom of the foot, especially when one foot is markedly warmer that the other. It may also be an indication that there is a decrease in blood flow to one leg or foot versus the other lower extremity. The symptoms described here may be the result of neuropathy, peripheral arterial disease, or both. In either case, a change in temperature or increased redness or a dusky, bluish color of one or both lower extremities should be cause for concern.
Anyone who is at high risk (diabetics, smokers and anyone over the age of 70 even if in good health) and has any of the symptoms discussed in this article, should practice daily inspection of the feet and legs, maintain diligent proactive skin care and should evaluated by a health care provider, preferably a vascular or wound specialist.
- Armstrong DG, Wrobel J, Robbins JM. Are diabetes-related wounds and amputations worse than cancer? Int Wound J. 2007;4(4):286–7.