Foot wounds and ulcers are caused by an injury to the skin and tissues layers. They typically occur in the feet or toes and take a long time to heal. Diabetic patients are more likely to develop foot wounds or ulcers. This is because high blood sugar levels damage nerves, damage the arteries that bring blood to the foot, and lower immunity, impairing the body’s ability to fight infection.

Limb amputation then becomes a high risk in diabetic patients because they may be unaware of foot injuries, allowing the condition of their foot wounds to worsen without treatment. As wound infection risks increase due to the lack of blood supply and a compromised immunity, wounds that do not heal may eventually develop into gangrene.

There are different types of foot wounds/ulcers, mostly caused by vascular problems that call for a visit to the vein clinic:

• Venous Ulcers: Usually occur in people with leg swelling and vein related conditions. They affect the area below your knees and are typically caused by venous insufficiency
• Neurotropic (Diabetic Foot) Ulcers: Often occur on the bottom of the feet in people with diabetes
• Arterial (Ischemic) Ulcers: Develop all over the feet in those with poor blood circulation or blocked arteries

Of all the types of foot ulcers, venous ulcers are the most common. They account for 80% to 85% of all cases. While most ulcers can heal within months, some ulcers may take up to years to heal, or may never fully go away, especially if you have an underlying condition.

Foot ulcers, if left untreated, can increase in size and depth, become infected and cause other foot related conditions, and even lead to reduced functioning in the feet, requiring amputation.

If you’re suffering from non-healing foot wounds/ulcers or diabetes, and are worried about foot wounds, the first thing to do is to get a vascular ultrasound done by a vascular doctor. This will help them determine your condition to devise the best treatment method. Your vascular doctor will work with a podiatrist for surveillance, as well as making sure that there are no other wounds. You will also be taught to look after your feet to prevent your condition from worsening or new foot wounds/ulcers from appearing.

Treatment Options

Balloon Angioplasty

This is a procedure used to open narrowed or blocked arteries in order to improve blood flow. It is a minimally invasive procedure requiring only local anaesthesia. A small balloon-tipped device is inserted through an artery in your leg, inflated to open the artery and restore blood flow, then deflated and removed from your body.

Offloading

As ulcerations typically occur in high-pressure areas, it is essential to reduce pressure and weight placed on foot ulcers in order to promote healing. ‘Offloading’ treatments refer to minimising or removing weight to reduce pressure, friction, and shear on foot ulcers.

There are many offloading techniques available, including total contact casting, half shoes, short leg walkers, padded socks, wheelchairs, and more. These are various tools and devices that can be used to relieve pressure and reduce the risk of needing amputation. 

Medication

Your vascular doctor may prescribe different types of medications to deal with various conditions that are causing your foot ulcers, such as antibiotics, antiplatelets, or anti-clotting medications to promote healing and blood circulation to treat foot ulcers. For example:

• Aspirin: This medication prevents the formation of thromboxane A2, which is a substance that fuels blood clots in the vascular system. It is essential for wound healing, but may hinder foot ulcers from healing. Aspirin also improves the complications of venous stasis, which is an inflammation of the skin in the lower legs as a result of chronic venous insufficiency, and thrombosis, which occurs when your blood vessels are blocked by blood clots.
• Becaplermin Gel 0.01%: This is a human platelet-derived growth factor for topical administration that promotes the healing of diabetic foot ulcers. 
• Pentoxifylline: Treats intermittent claudication and reduces blood viscosity to help with blood flow.  

Debridement

Debridement is the removal of dead or infected skin tissue to aid in the healing of a wound. The removal of all nonviable tissue reduces infection risk, and promotes the formation of healthy granulation tissue, which aids in healing.

Surgery & Therapy

There are other surgical methods and therapy offered by vein clinics in Singapore you can explore to help your foot ulcers heal. Many of these treatments also promote vascular health to not only treat your current condition, but also to prevent similar issues from arising again. 

1. Revascularisation: Restores arterial blood flow to the foot 

2. Extracorporeal Shock Wave Therapy: Shock waves with tissue regenerative properties, anti-inflammatory and pro-angiogenic effects are applied to the wound to reduce wound size, decrease necrotic tissue and increase blood flow

3. Negative Pressure Wound Therapy: Provides an environment of sub-atmospheric pressure which helps to enhance healing rates, promoting the delivery of oxygen and nutrients to the wound and by stimulating cellular proliferation

4. Skin Grafts: Reconstruct weakened or missing skin, promoting healing and reducing the risk of infection

5. Vascular Surgery: Restores proper blood flow to the wound site, promoting healing and healthier skin

Aside from the treatment and prevention methods mentioned above, the vascular doctor may recommend a variety of other ways to prevent or treat foot ulcers. It is also important that you consciously manage proper foot care to prevent your foot ulcers from worsening.

At Cheng SC Veins and Endovascular Clinic in Singapore, we provide a range of vascular and amputation prevention treatments to help manage your foot wounds and ulcers. Contact us today to explore our treatment methods.