Trophic Lesions of Vascular Origin: Leg Ulcers (Arterial, Venous, or Mixed) and Diabetic Foot

Venous Leg Ulcer

Most leg ulcers are of venous origin and are typically associated with traumatic injuries or underlying pathological conditions. They can be venous, arterial, or mixed in origin. Ulcers significantly impact quality of life and are often linked to factors such as trauma, thrombosis, obesity, aging, certain medications, mobility issues, lifestyle choices, pregnancy, and family history.

Venous ulcers develop due to the veins' diminished ability to promote blood return to the heart, leading to venous hypertension. This condition causes fluid leakage into the surrounding tissues, which triggers inflammation and skin lesions. Symptoms of venous insufficiency include hyperpigmentation of the skin, edema, pain, dilated veins around the ankle, lipodermatosclerosis, and varicose eczema.

Early diagnosis is essential for effective treatment, which aims to improve the patient's quality of life, manage pain, and reduce the risk of infection. Post-healing care is also crucial to prevent recurrence, which includes regular physical exercise and the appropriate use of creams to maintain skin health.

Diabetic Foot

Diabetic foot is associated with reduced foot sensitivity due to nerve damage, making the skin more susceptible to injury and infection. Common signs include changes in foot color, dry and flaky skin. It is essential to thoroughly dry and moisturize the feet after washing to prevent complications.

Diabetic foot tends to develop calluses, particularly on the sole, which, if untreated, can lead to ulceration. Proper footwear and early treatment of ulcers are critical, as failure to address this condition can result in amputation. Often, debridement and antibiotic treatment are necessary, and in severe cases, consultation with a vascular surgeon is required. Effective diabetes management is crucial because high blood sugar levels hinder infection control.

Careful inspection of the feet, toes, and nails for blisters, cuts, scratches, or ingrown toenails that could lead to ulcers is vital for diagnosis and monitoring. Neuropathy and peripheral arterial disease are common complications associated with diabetes. Therefore, assessing skin sensitivity and checking for arterial pulses are important steps.

Additional examinations include:

• X-rays: Evaluate bone alignment changes or bone mass loss, helping to prevent fractures and conditions like Charcot foot.
• Magnetic Resonance Imaging (MRI): Assesses the extent of damage caused by ulcers.
• Blood tests: Recommended when signs of infection such as redness, swelling, or warmth are present.

Simple measures like proper nail trimming, wearing suitable footwear, and avoiding walking barefoot are essential. To improve circulation, elevate the feet when sitting, move feet/toes several times a day, and regularly stand on tiptoes. Avoid crossing legs for long periods and wearing tight socks. Smoking cessation is crucial, as tobacco use impairs circulation and increases the risk of amputation in diabetics.

Exercise and Prevention

Physical activity is key in preventing diabetes and diabetic foot. Engaging in activities like walking, swimming, dancing, or cycling promotes circulation and helps maintain blood pressure, cholesterol, and blood sugar levels. It is important to select exercises appropriate to individual limitations and follow professional guidance.