What is a foot ulcer?

An ulcer is a medical term for an open sore. Foot ulcers are serious and can take weeks or months to heal. Occasionally they can deteriorate and lead to severe infection, gangrene or amputation.

What causes foot ulcers?

• Ill-fitting footwear
• Injury
• Walking barefoot
• Poor foot hygiene
• Dry skin

Foot deformity, poor blood supply or nerve damage to the feet can increase the risk of foot ulcers.

How are foot ulcers treated?

Following an assessment, a plan of treatment will be agreed between yourself and your consultant / podiatrist / nurse. This will include: Debridement when appropriate. Debridement is a term used to describe the removal of hard skin, or dead or infected tissue. Debridement is not normally painful. Research shows that debridement helps foot ulcers to heal faster.

Benefits of debridement

• reveals the full size and nature of the ulcer
• reduces pressure on the edge of the ulcer
• reduces the risk of trapped infection.

Following debridement the ulcer may appear bigger, or may bleed, but it will be a cleaner ulcer. The quickest and usually the best way to debride ulcers is with a scalpel blade. Sometimes a suitable dressing may be applied to encourage the ulcer to debride itself.

Pressure relief is a crucial part of your treatment plan. Any pressure exerted on your ulcer, either from footwear or from walking, will slow down the healing process.
There are many different ways of taking pressure off your ulcer. You and your podiatrist can decide together which would be best for you.

Regular dressing of your ulcer – there are many different kinds of ulcer dressings, your podiatrist/ nurse will suggest the best one for you.

Will I need special tests?

Sometimes tests may be necessary, these may include

• A swab or tissue taken from the ulcer to help identify bacteria which may be causing infection
• Circulation tests on your legs and feet
• Blood tests
• X ray or scan to help determine if infection is in the bone.

Do I need to take antibiotics?

Only if your ulcer is infected. You will receive individual advice if you develop an infection.

How long do I need to take antibiotics for?

7 days to several months depending on how deep the infection is. You need to take your antibiotics regularly and complete the course. Report diarrhoea and vomiting immediately to your doctor.

Do’s and don’ts

  • Do rest your foot as much as possible, keeping your legs elevated.
  • Do keep your blood glucose controlled. This is very important to help healing take place.

NOTE: If you are taking an SGLT2 inhibitor e.g. Canagliflozin, Empagliflozin, and Dapagliflozin it is important that you should have this agent reviewed and converted to another glucose lowering drug.

  • Do give up smoking – ask your doctor, nurse or podiatrist for advice
  • Do keep your dressing in place and keep it dry. If you have problems with your dressing contact your podiatrist or nurse
  • Do use any special footwear / devices / insoles you have been provided with
  • Don’t sit or stand in one position for a long time
  • Don’t sit too close to the fire or heater
  • Don’t stop taking antibiotics in the middle of a course unless directed, as it encourages the growth of superbugs. Always consult your doctor, podiatrist or nurse first.

Remember - If you notice any change to your foot such as

  • Are there any new ulcers or blistered areas?
  • Colour change - is there any redness or bluish marks like bruising of the skin around the dressing?
  • Swelling - has your shoe become tight?
  • Discharge - is there blood, pus or watery fluid coming through the dressing where previously it was dry?
  • Is there pain or throbbing in the area around the ulcer?
  • Smell - has your foot developed an unpleasant smell?
  • Do you feel unwell with fever, flu-like symptoms or has your diabetes control become significantly worse?

If the answer to any question is YES, then you should contact one of your diabetes care team THE SAME DAY. If your GP or podiatry clinic is closed, contact the Out of Hours service. Tell them you have diabetes and that your foot ulcer has changed.

After healing

Even after your ulcer has healed, you will need to take special care to prevent another ulcer developing.

  • Check your feet every day. If you find any areas of broken skin, apply a sterile dressing holding it in place with tape or bandage.
  • Do not put tape on fragile skin or wrap tape around toes. Make sure the bandage is not too tight.
  • Contact your podiatrist, doctor or nurse as soon as possible, for further advice.

If you have been given special footwear or insoles, wearing

Contact details for help and advice

Carlisle Podiatry Service
Carlisle Health Care
Eden Street
Carlisle
CA3 9JZ

Call 01228 608020

Eden Podiatry Service
Penrith Health Centre
Penrith
CA11 8HW

Call 01768 245628

Allerdale Podiatry Service
Workington Community Hospital
Park Lane
Workington
CA14 2RW

Call 01900 705120

Copeland Podiatry Service
Flatt Walks Health Centre
Whitehaven
CA28 7QE
Call 01946 692173

GP, nurse practitioner or practice nurse – contact the surgery you are registered with.

Multidisciplinary Diabetic Foot clinics (MDFT) provided at the Cumberland Infirmary, Carlisle and West Cumberland Hospital, Whitehaven:
Diabetes Centre
Cumberland Infirmary
Newtown Rd
Carlisle
CA2 7HY

Call 01946 68599. Monitored Monday to Friday between 9am and 5pm.

NHS out of hours service contact 111.

A&E department at Cumberland Infirmary or West Cumberland Hospital.

Confidentiality

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302