By regularly monitoring your feet you can become familiar with what is normal for you and what may be a concerning change.
Many problems can be addressed if they are caught early, the cause of the problem identified, and appropriate action taken to reduce the potential for harm e.g. changing shoes or applying moisturiser more frequently.
Sometimes however a problem may develop quickly though.
Critical Limb Ischaemia
If you have been advised that you have poor circulation to your lower limb you may find that it can develop a generalised pain when the limb is raised, and gravity is not helping blood get down to your lower limb and foot. This is a sign that the problem is getting worse. Ideally it is best to follow the advice in our section on Peripheral Arterial Disease before it gets that troublesome, or to make some lifestyle changes and do more moving about or exercises for leg muscles if it is starting to be a problem.
If you develop a severe burning pain in your legs and feet that continues even when you are resting, this may be a sign that you have a blockage in one of your blood vessels. If your leg/foot has gone very pale, cold and numb this would suggest this is the case and if the skin starts to look mottled and looking darker over a short period of time you need to contact your GP or if not possible, ring NHS 111 (dial 111) for advice. They may advise that you need to visit the Emergency Department at your local hospital to get treatment.
Wound/Ulcer
If you have developed a wound on your foot you may need the help and advice of a podiatrist. If it is a small scratch and you normally heal well you may just need to follow the advice in the Woundcare leaflet, but if you have underlying medical conditions or poor circulation you may need to be referred to the Podiatry Service by your GP or through the self-referral route. If you are already registered as a PIFU patient (Patient Initiated Follow Up) with Podiatry Services you need to contact us on 01752 434855 to arrange an appointment. We will ask some questions to make sure we arrange a suitable appointment for you or advise where you need to get help and support.
For some basic advice on wound care please read here How do I clean a wound? – NHS (www.nhs.uk)
Infection
If you have a wound and it is not healing although you have made suitable changes to ensure it is protected with a sterile dressing and no further harm is occurring, it is possible it has developed an infection which is preventing it healing. You may also notice some changes as the area becomes warmer or hotter compared to the same area on the other foot, it may look more pink or red around the wound and it may also have more discharge leaking onto the dressing. This discharge may also start to look more cloudy, thicker and could smell a bit (pus). Sometimes you may not need to remove a dressing to notice this if the redness is spreading or the discharge is leaking through the dressing.
The wound may also become more painful. If you have been diagnosed with a loss of sensation in your feet (sensory neuropathy) this may be less noticeable, but if you are getting pain where it was not apparent previously then this may be a sign the wound is infected. It will likely show the signs above too.
Sometimes the signs may not be obvious if you have poor circulation. If you have been advised that you have poor circulation (Peripheral Arterial Disease) it is likely that your wound will take longer to heal because of this. Due to the time it takes to heal there is more risk of infection so you should check the area of the wound daily to see if there any signs or symptoms of infection and contact your GP or NHS111 for advice if it shows no signs of healing over time, is getting worse or is showing some signs of infection. If it is infected it may show some of the signs listed above to a lesser degree, but you may notice that the area is becoming more painful although you have removed the cause of injury.
If you are under the care of a healthcare professional they will likely have advised on whether you can change the dressings to check, or whether you need to wait until your appointment with them, but you can still observe the area around the dressing to check for any spreading redness and check the dressing to see if there is any sign of discharge on the outside. If the redness is spreading beyond the dressing you need to contact your GP or NHS111. The discharge showing through the dressing may be something that can wait until your next appointment if it is due soon or you may need to contact your surgery or healthcare professional to ask about bringing the appointment sooner if the discharge is heavy.
If you think your wound is infected you need to contact your GP to discuss this. They may provide you with advice and prescribe you antibiotics if they think you need them. Do not wait until you attend your Podiatry appointment to ask them to arrange it as this may cause an additional delay. If you do not have a Podiatry appointment booked you may want to arrange one – advising them of your concerns when asked the booking questions.
If you are having problems with antibiotics you have been prescribed you should contact the prescriber or ring NHS111.
For more advice about antibiotics please read here Antibiotics – NHS (www.nhs.uk)
Sepsis
Sepsis is a life-threatening reaction to an infection.
It can be hard to spot sometimes as there are lots of potential symptoms but if someone appears hard to rouse, confused, slurring and not themselves please check the symptoms here Symptoms of sepsis – NHS (www.nhs.uk) and ring NHS111, dial 999 or go to your local Emergency Department. The NHS website and NHS111 will tell what actions you need to take.
Necrosis
Necrosis is the death of body tissue. It occurs when there is too little blood flow to the tissue.
When this occurs on the foot it can be where a blood vessel that has been becoming blocked over time is unable to continue functioning or becomes blocked with a small blood clot. It can also result from an initial injury where there is insufficient blood flow to be able to recover. Necrosis cannot be reversed. When large areas of tissue die due to a lack of blood supply, the condition is called gangrene.
The dying skin will start to change colour and it may resemble an infection but will be very painful. If the condition of the skin deteriorates but remains dry it will eventually become black and leathery. This area will eventually detach from the underlying skin and depending on where it was, the area beneath will try and heal over. Where toes are affected it may mean the loss of the toe at the level of the necrosis.
If the necrosis is wet then it may appear yellow, green, or brown and might be moist, loose, and stringy. This presents a raised risk of infection so will need to be managed by a healthcare professional. The goal will be to reduce the amount of dead tissue present and manage the moisture levels to reduce the risk of infection and harm.
If you have a wound that looks like this on your foot you should be seen by healthcare professionals who can perform the relevant assessments and provide appropriate treatments to address the underlying cause as some wounds may be due to poor arterial blood flow and some due to poor venous blood circulation. If you are on the Podiatry Service PIFU list you can contact us directly for an appointment and should mention about the wound and appearance. If you are not registered with the Podiatry Service you may need to go through your GP surgery and they will direct you to the appropriate Service for your needs or you could self-refer to access the Service.
Charcot Foot
If you have neuropathy (loss of sensation) in your feet and you start to experience significant pain it is a sign that something is wrong. If you have been conducting regular foot checks or someone can help you by checking your foot and noting any changes, this can be helpful when you ring for help or advice.
Where someone has neuropathy and good circulation there is sometimes a chance that where a foot has become warm, swollen and painful over a joint, typically the midfoot area, you may have developed a condition which causes changes to the joint, called a Charcot foot or Charcot Joint. This is often associated with diabetes but can also occur without a diagnosis of diabetes. You may notice the onset over a few days. You may not feel pain due to the severity of your neuropathy, but if your foot is presenting with a red, hot, swollen area over a joint it will need investigating. If you suspect that you may have developed a Charcot foot it is essential that you rest the foot until you can arrange a review or assessment. Weight-bearing activity such as walking can damage the joint and cause deformity which in turn can lead to ulceration of the skin. This can then be hard to heal due to the underlying deformity causing pressure over the vulnerable area.
It is essential that you keep weight-bearing activity to a minimum and to contact a Podiatrist or your GP as soon as possible; you should then be referred to the multi-disciplinary team urgently if they suspect it is a Charcot foot. Alternatively, you can visit your local Emergency Department.