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What is a foot ulcer?

The development of foot ulcers in people with kidney disease is serious, especially if they become infected, as they are linked to an increased risk of heart attacks, strokes, amputations of the foot or leg and early death.

You have a foot ulcer. This means an area of skin has broken down and the tissue under it is now exposed.
In some people with renal complications, the skin does not heal very well and is likely to develop an ulcer or infection after only a minor injury.

A foot ulcer can become infected and the infection may become severe. It is important that you look after your foot ulcer to reduce the risk of an infection.

The development of foot ulcers in people with kidney disease may lead to serious complications and they are linked to an increased risk of heart attacks, strokes and amputations of the foot or leg.  

Controlling your cholesterol and blood pressure, quitting smoking, increasing cardiovascular exercise, controlling weight and managing any other conditions you may have (such as diabetes) helps to reduce the risk of these life- and limb-threatening problems.  Managing any excess fluid is also important. 

People with foot ulcers will need to ask their Podiatry Team about non-weight-bearing cardiovascular exercise so as not to risk further harm to the damaged foot.

Note: You may be at further risk of cardiovascular problems if you have a family history of heart disease.
As you have a foot ulcer, you will need regular podiatry treatment. Your podiatrist will draw up a treatment plan for you.

Podiatry treatment for your foot ulcer.

Foot ulcers are sometimes hidden beneath hard skin and can gather dead tissue around them. The podiatrist will need to remove this to help your ulcer to heal. This can cause the ulcer to bleed a little but this is completely normal. Do not try to treat the ulcer yourself.

What can I do to reduce the risk of developing problems?

Do not touch the dressing unless you have been properly shown how to remove and replace it and you have suitable dressings to replace the one you are changing.

Continue to check your feet every day

If you discover any more problems, or if you are concerned about the treatment of your foot ulcer, contact your Multi-Disciplinary Foot Care Service, local Podiatry Department or GP for advice immediately. 

Do not get the dressing wet

Getting the dressing wet may prevent healing or allow bacteria to enter the ulcer. This will cause more problems. Your podiatrist may be able to supply you with a dressing protector to keep the dressing dry, or they may give you a form to take to your GP to get a dressing protector on prescription. The dressing protector will allow you to have a bath or shower safely while keeping your dressing dry.

Moisturise the surrounding area of your feet

If your skin is dry, apply a moisturising cream every day, avoiding areas of broken skin and the areas between your toes.

Do not stand or walk on the affected foot

Avoid any unnecessary standing or walking. A wound cannot heal if it is constantly under pressure. Rest as much as possible and keep your foot up to help it to heal. Use anything your podiatrist recommends or gives you to relieve the pressure on your foot.

Danger signs

During your treatment for this ulcer, if you notice any of these danger signs you must contact a member of your Multi-disciplinary Foot Care Team, local Podiatry Department or GP for advice as soon as possible (within 24 hours).

•Is there any pain or throbbing?

•Does your foot feel hotter than usual?

•Are there any new areas of discolouration, inflammation or swelling?

•Is there any discharge?

•Is there a new smell from your foot?

•Do you have any flu-like symptoms?

•Have you noticed a rash?

•Are you becoming breathless?

•Is your body temperature above 38.3ºC (101ºF) or below 36ºC (96ºF)?

•Is your heart rate higher than 90 beats per minute?

If you discover any new breaks in the skin or blisters, cover them with a sterile dressing. Do not burst blisters.

If your Multi-disciplinary Foot Care Team, local Podiatry Department or GP are not available, and there is no sign of your foot healing within 24 hours, go to your local accident and emergency department.

Redistributing pressure on the foot

Use any device which your podiatrist or orthotist provides to help relieve the pressure on your foot. You may be asked to wear a cast or walking boot or special shoe until your ulcer has healed. You should wear this at all times when putting weight on your foot.

Keep checking both feet between appointments with your specialist foot service, following the care and advice you have been given about foot protection. Make sure you wear the correct footwear on the other foot as there will be more pressure on this foot, which could cause a further problem.

You can get advice from your specialist diabetes foot service about weight-bearing, and aids such as crutches, sticks and wheelchairs that help keep the weight off your foot.

You should not wear any other footwear until your podiatrist tells you that you can wear your own shoes again.

Podiatry appointments

Always attend your appointments to have your ulcer treated. You may need regular appointments until the wound has healed. Your appointment may be with a district nurse, a practice nurse, a treatment room nurse or your podiatrist.

Antibiotic treatment

You may be prescribed antibiotics if there are signs of infection in the wound or in the nearby tissue. Report any problems you have with the antibiotics (rashes, nausea or diarrhoea) to the person who prescribed them for you. If this person is not available, contact your GP immediately. Do not stop taking your antibiotics unless the person treating you or your GP tells you to do so. If the infection is getting worse (you have increased or spreading redness, pain or develop flu-like symptoms) you may need to go to hospital immediately to help protect your limb and even save your life.

Operations 

Sometimes, if an infection becomes severe, you may need a small operation to clean out the wound. 

If an infection is very severe, an amputation may be needed to save healthy parts of the foot. 

If your circulation is reduced, you may be referred for a small operation to increase blood supply to the ulcerated area.

Developed by the London Foot Care Strategic Clinical Network and the London Renal Strategic Clinical Network with help from service users
Based on the original leaflet produced by the Scottish Diabetes Group – Foot Action Group
Owned by the Royal College of Podiatry ©                       
Published date: Month,  May 2024         
Review date: Month, May 2027

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The National Kidney Federation cannot accept any responsibility for the information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.