Pressure ulcers are sores that form on parts of the body where something rubs or presses against the skin constantly for long enough to cause the skin to break down.

They often occur on parts of the body where the skin is stretched tightly against a bone, such as on the heel or the ankle bone—more specifically, the lateral malleolus (in more familiar terms, this is that knob of bone at the end of the fibula that causes you so much misery when you bang it against the coffee table).

What Are The Symptoms of Pressure Ulcers?

Pressure sores on the feet and ankles begin as areas of red, inflamed skin. Over time, the inflammation gets worse, and a blister develops.

This blister eventually becomes an open sore, and if treatment has not been administered before this, it is now a very serious condition. Skin that is this badly compromised is susceptible to infection, which can affect the entire body.

Pressure ulcers are categorized according to their severity:

• Stage I: An area of skin (usually—but not always—right over a bone) that does not blanch; that is, it does not turn white when pressure is applied to it with a finger or other object. Stage I pressure ulcers on the ankles and feet can be harder to detect in this manner in people with darker skin, although the affected skin may appear blue or purple, and there may be sufficient discomfort to motivate the affected person to see a doctor. Regardless of skin color, the skin will be tender to the touch, and may be slightly warmer than the surrounding skin.
• Stage II: The epidermis (the outer layer of the skin) is severely damaged, and may even be gone. The affected area becomes a blister and then an open sore. Redness and inflammation are apparent on the skin surrounding this blister or sore.
• Stage III: Tissue loss becomes more apparent at this stage. Tendons and muscles are not exposed (yet), but subcutaneous fat may be. The sore has now become a sunken hole; this is known as a crater.
• Stage IV: At this stage the sore is much deeper, and there may be damage to muscles, tendons, and even bone.

Why Do I Have Pressure Ulcers on my Feet and Ankles?

Pressure sores on the feet and ankles are caused by pressure that limits blood flow through the skin in the affected area. This often occurs in people who are less mobile—for example, people who are bedridden or confined to wheelchairs.

Pressure from the weight of the affected person against the bed (or even bed sheets) or the surface of a wheelchair can cause pressure ulcers.

What Are The Risk Factors for Pressure Ulcers?:

People with fragile skin (for example, the elderly) are at additional risk, as are people whose nutrition is poor. Diabetes is also a significant risk factor for pressure sores on the feet.

One of the reasons pressure sores are so common among the disabled is that many such people have impaired sensation of pressure and touch due to spinal cord injuries. Because of this, they may not be alerted by pain or discomfort to the need to change position.

People who are bedridden for extended periods may lose a great deal of weight, which reduces the cushioning around their bones, making them more susceptible to pressure sores.

Which Complications of Pressure Ulcers Develop?

The most serious complication that can occur as a result of a pressure ulcer on your foot or ankle is infection and sepsis. This occurs when bacteria enter the bloodstream through the compromised, ulcerated skin.

Infection then spreads throughout the body, endangering the patient’s life. Sepsis can also take the form of septic arthritis, a dangerous infection of the joints. If treatment is not administered, there is also the risk that gangrene could set in.

Even if sepsis does not occur, the patient is vulnerable to cellulitis infection of the skin, which can cause severe pain and swelling.

How Are Pressure Ulcers Treated and Prevented?

If you have developed a pressure ulcer on your foot, heel, or ankle, do not massage the skin surrounding the sore; this can further damage the skin and worsen the problem. The best thing to do is to see a doctor as soon as possible, especially if you are experiencing any of these symptoms of infection:

• Pus coming from the sore
• Foul odor emanating from the sore
• Unusual warmth and swelling of the skin surrounding the sore
• Fever

Medical treatment usually involves antibiotics, and possibly debridement, a process by which dead or infected tissue is removed from the wound.