If you are immobile keep your feet elevated as much as you can to avoid DVT
Q: My legs are itchy and I have now developed a small open ulcer, having had diabetes for 21 years. My doctor has prescribed steroid and emollient creams and advised getting air to it, which I am doing. I have varicose veins in that area and the surrounding skin is very sore to touch. Is there anything else I can do to get this ulcer to heal?
Skin damage below the knee is a quite a problem as the tissues in that area are particularly vulnerable to many and various diseases including diabetes and varicose veins. Once the skin is breached it can be a very slow and meticulous process to get it to heal. As well as creams to improve the quality of the skin you may need special dressings and pressure bandages to optimise the performance of the damaged veins in your legs. In addition your diabetes needs to be as well controlled as possible. It is a combination of small improvements in lots of areas that will assist healing. If you have not received an experienced nurse’s advice then you should do so.
Diabetes can damage the lower legs by various means, including impaired arterial blood supply and damaged nerve endings. The combination can lead to unnoticed damage since you may not always feel the initial injury and the impaired blood supply then delays healing. Varicose veins have to work against gravity to return blood to the heart and their efficiency is also diminished by excess weight or inactivity. Long-term skin changes include redness, itching, thin skin and skin staining. As you can imagine, these changes do not assist wounds to heal.
Deep vein thrombosis risk
Q: I have arthritis and have great difficulty walking so spend most of my time sitting still. Am I at risk of DVT and what precautions should I take?
Immobility increases the risk of a deep vein thrombosis (DVT), particularly if it’s due to injury, surgery or damage to the lower legs. Most DVTs occur in this area, starting as a blood clot in the deep, large veins of the calf. Blood returning to the heart up these veins is travelling slowly; anything which further slows this down can contribute to the development of a clot. The clot slowly enlarges and can become extensive with serious complications ensuing if the clot breaks up and travels into the lungs where it is called a pulmonary embolus.
If you are immobile then it is important that your lower legs are not always the lowest part of your body; keep them elevated as much as you can and wear compression stockings which empty the veins of blood and encourage flow back up the leg. The best option, of course, is to stay as mobile as possible since muscle activity in the legs promotes blood flow through the veins in question.
Dr David Roche is a GP in Sussex and answers readers’ questions every month in Saga Magazine. He can only answers questions there or on the Saga health website; email your questions to email@example.com and he will answer as many as he can.