Ulcers & Sore Spots

What Is a Foot Ulcer?

A foot ulcer is an open wound or sore on the foot that does not heal in a normal time frame. Unlike a simple cut or abrasion, ulcers tend to be deeper, involve more layers of tissue, and are resistant to healing due to underlying factors such as poor circulation, nerve damage (neuropathy), or compromised immunity.

Foot ulcers are most commonly found on the bottom of the foot, particularly under the ball of the foot or the big toe. They can range from shallow surface lesions to deep wounds that involve tendons, bone, or joint structures.

Who Is at Risk?

Foot ulcers can affect anyone, but certain conditions dramatically increase risk:

• Diabetes — the leading cause of foot ulcers worldwide. Diabetic neuropathy reduces pain sensation so wounds go unnoticed, while poor circulation impairs healing. See our Diabetic Foot Care page for more.
• Peripheral arterial disease (PAD) — reduced blood flow to the lower extremities impairs tissue repair
• Venous insufficiency — poor blood return from the legs causes tissue breakdown, especially around the ankles
• Neuropathy from other causes — nerve damage from alcoholism, kidney disease, or other conditions removes protective pain sensation
• Obesity — excessive body weight increases pressure on the soles of the feet
• Previous ulceration — a history of foot ulcers significantly increases the risk of recurrence

Causes

• Sustained pressure on a bony prominence (most common cause)
• Friction from ill-fitting footwear rubbing against the skin
• Minor cuts, blisters, or abrasions that fail to heal
• Corns or callouses that break down under continued pressure
• Foreign bodies inside the shoe that go unnoticed due to neuropathy

Treatment

Wound Debridement

The removal of dead, infected, or damaged tissue (debridement) is the cornerstone of ulcer treatment. This creates a clean wound bed that is capable of healing and allows the depth and extent of the ulcer to be accurately assessed.

Offloading

Removing pressure from the wound is essential — the ulcer cannot heal if it continues to bear weight. Methods include specialized footwear, custom orthotics, padding, removable cast walkers, or total contact casts.

Infection Management

Signs of infection (redness, warmth, swelling, drainage, fever) require prompt antibiotic treatment. Deep or bone infections (osteomyelitis) may require IV antibiotics or surgical debridement.

Advanced Wound Care

• Specialized wound dressings that maintain a moist healing environment
• Growth factor treatments to stimulate tissue regeneration
• Skin grafting or bioengineered tissue substitutes for large or difficult wounds

Treating Underlying Causes

Lasting healing requires addressing the root problem — whether that's improving circulation, managing blood sugar, correcting foot mechanics with orthotics, or modifying footwear. Without treating the cause, ulcers almost always recur.