Some rheumatic conditions can cause the skin on your feet to change, becoming thinner and drier. Sometimes rheumatic conditions can cause the supply of blood to your feet to be reduced or in some cases can affect the feeling in your feet. Arthritis can also cause your feet to change shape, which means your shoes may not fit as well and your feet are at risk of being rubbed. When combined these changes mean that you may be at increased risk of getting a foot wound (ulceration).
Having a rheumatic condition can also mean that foot wounds heal more slowly. Some of the medications that are used to treat rheumatic conditions can slow down healing because your immune system is reduced. This can mean that your body's ability to detect and respond to infection quickly is reduced.
This guide is designed to give you advice about how to avoid getting a foot wound and how to look after a wound if you have one.
How can I prevent a foot wound?
There is limited research about the causes of foot wounds for people with rheumatic conditions. However, there are some things that are known to increase your risk of developing a foot wound. Things that you can do to prevent a foot wound incude:
- Check your feet daily
- Keep as active as possible – this helps to keep the blood supply to your feet in a good condition
- Avoid socks that are too tight or rub
- Stop smoking
- Check your shoes fit – you may find you need a larger size shoe if your arthritis is in a flare
- Moisturise your feet regularly to prevent dryness and cracks in the skin
- Use a cream with urea in to reduce the build-up of hard skin
- Use a cream to prevent and treat chilblains
- Regularly file areas of hard skin
- Regularly cut and file your nails
- Get advice from a podiatrist straight away if you notice a change in the shape of your foot
- Get advice from a podiatrist straight away if you notice red, hot, or swollen areas on your foot.
I have just found a new foot wound – what should I do?
If the area is dirty you can clean it by bathing your foot in warm salty water. Pat the area dry with a clean piece of gauze (paper towel can be used but you should avoid tissue where possible). Do not touch the wound. Cover the area with a sterile plaster or other sterile dressing material. When securing any dressing avoid making a closed loop around the foot or toe as this can reduce the blood flow in the foot leading to more problems. Do not apply any other creams or products to your foot wound. Foot wounds should be kept dry and covered until they are fully healed.
Contact your podiatrist, nurse or GP immediately to let them know that you have a wound, arrange an appointment for it to be checked and get advice about a suitable dressing if needed. Do not wait to contact your podiatrist, nurse, or GP because it is important for wounds and any infection to be treated quickly. Not treating infection in your foot quickly can be very serious and life-threatening.
How can I tell is there is an infection and what should I do?
If the area around the new wound appears red, hot, and swollen this can be a sign of infection and you need to seek urgent medical advice. Medical advice can be sought from podiatrists, health professionals at your GP practice or pharmacists.
|If you notice the redness around your foot wound becoming larger and spreading up your leg, this is a sign of serious infection and you need to see urgent medical attention. Urgent medical attention can be sought by telephoning 111 if you are in the UK.|
Other signs of infection can include:
- Your wound weeps more
- You notice an unpleasant smell
- You notice the surface of the wound is no longer pink in colour
- You notice your wound staying the same size or getting bigger.
If you have a rheumatic condition you may notice only some of the above signs of infection. The medication that you take can hide some of the signs of infection such as pain, redness, heat or swelling.
It is important to discuss your use of medication with your medical team if you have infection. Check your wound daily for all the above signs of infection unless you have been advised not to remove a dressing by a podiatrist.
How can I help my foot wound to heal quickly?
One of the main ways that you can help your wound to heal more quickly is to reduce your risk of infection. You can help prevent infection by:
- Keeping your wound covered with a sterile dressing
- Keeping your dressing dry; bacteria like to move around and spread in wet areas
- If your dressing accidentally becomes wet, remove it immediately and replace it with a new one
- Replace the dressing regularly; if you notice discolouration coming through your dressing it needs to be changed.
Other things you can do:
- Check socks and shoes for rubbing against your wound site
- Rest with your feet raised up on a foot stool or reclining chair
- Wear loose fitting socks
- If you are sitting for more than 30 minutes at a time, move your feet and ankles around to help keep the circulation in good order
- Drink plenty of water regularly throughout the day.
Why does a podiatrist remove the skin around the wound?
As part of the normal healing process, wounds produce skin around their edges. Sometimes the presence of excess skin can slow down the healing process. Podiatrists will remove excess dead skin to help your wound heal more quickly; they will not remove newly healed skin. It is not usually painful when the podiatrist removes the excess skin.
Why might I need to stop or change my arthritis medication?
Some medications used to treat rheumatic conditions work by reducing the activity of your immune system. If you develop a foot wound, your immune system is needed for healing. In some cases, it may be necessary to stop or reduce your medication to help your foot wound to heal. If you develop an infection in your foot wound you may need a course of antibiotics to treat this. Sometimes it is necessary to stop some medication whilst you complete your course of antibiotics. Any decision to reduce or stop your arthritis medication should always be made by a trained healthcare professional.
When should I get expert advice?
If you have a new foot wound, you should get advice from a podiatrist or a member of your healthcare team straight away.
If you have any concerns or questions about a foot wound, you should always get advice from a podiatrist or a member of your healthcare team.
Download our leaflet on How to prevent or look after a foot wound if you have arthritis
This series of information leaflets was developed, approved and ratified by the following organisations:
- Università degli Studi de Milano-Biococca
- Cardiff Metropolitan University
- Royal College of Podiatry
- GIDIF RNM, Universidad de Malaga
- The National Axial Spondyloarthritis Society
- Homerton University Hospital NHS Foundation Trust
- Midlands Partnership NHS Foundation Trust
- Solent NHS Trust
- Walsall Healthcare NHS Trust
- National Rheumatoid Arthritis Society (NRAS)
- University of Leeds
- University of Southampton