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Kidney disease is a lifelong condition which may cause foot problems. Some of these problems can occur because the nerves and blood vessels are damaged.

This can affect:

- the circulation in your feet (ischaemia); and
- the feeling in your feet (peripheral neuropathy).

These changes can be very gradual and you may not notice them. This is why it is essential you receive a foot screening and assessment by a podiatrist every year. You can then agree a treatment plan to suit your needs.

You have a foot ulcer. This means an area of skin has broken down and the tissue under it is now exposed.

In some people with renal complications, the skin does not heal very well and is likely to develop an ulcer or infection after only a minor injury.

A foot ulcer can become infected and the infection may become severe. It is important that you look after your foot ulcer to reduce the risk of an infection.
The development of foot ulcers in people with kidney disease may lead to serious complications and they are linked to an increased risk of heart attacks, strokes and amputations of the foot or leg. Controlling your cholesterol and blood pressure, quitting smoking, increasing cardiovascular exercise, controlling weight and managing any other conditions you may have (such as diabetes) helps to reduce the risk of these life- and limb-threatening problems.

People with foot ulcers will need to ask their Podiatry Team about non-weight-bearing cardiovascular exercise so as not to risk further harm to the damaged foot.

Note: You may be at further risk of cardiovascular problems if you have a family history of heart disease.

As you have a foot ulcer, you will need regular podiatry treatment. Your podiatrist will draw up a treatment plan for you.

Prescription footwear and insoles can reduce the risk of ulcers but cannot remove the risk altogether.

Danger Signs
During your treatment for a foot ulcer if you notice any of these danger signs you must contact a member of your multi-disciplinary Foot Care team, local podiatary department, or GP for advice as soon as possible (within 24 hours)

• Is there any pain or throbbing ?
• Does your foot feel hotter than usual ?
• Are there any new areas of discolouration, redness, inflammation or swelling ?
• Is there any discharge ?
• Is there asny new smell from your foot ?
• Do you have any flu-like symptoms ?
• Have your noticed a rash ?
• Are you becoming breathless ?
• Is your body temperature above 38.3°C (101°F) or below 36°C (96°F) ?
• Is your heart rate highter than 90 beats per minute ?

If you discover any new breaks in the skin or blisters, cover them with a sterile dressing. Do not burst the blisters.

If your multi-disciplinary Foot Care team, local podiatry department or GP are not available and there is no sign of your foot healing within 24 hours, go to your local accident and emergency department.

Podiatry treatment for your foot ulcer

Foot ulcers are sometimes hidden beneath hard skin and can gather dead tissue around them. The podiatrist will need to remove this to help your ulcer to heal. This can cause the ulcer to bleed a little but this is completely normal. Do not try to treat the ulcer yourself.

How to look after your foot ulcer

Do not touch the dressing unless you have been properly shown how to remove and replace it and you have suitable dressings to replace the one you are changing.

Continue to check your feet every day

Continue to check your feet every day for any other problem areas or danger signs.

Danger signs

You should pay close attention to any of the following danger signs when checking your feet.

- Is there any new pain or throbbing?
- Does your foot feel hotter than usual?
- Are there any new areas of redness, inflammation or swelling?
- Is there any discharge?
- Is there a new smell from your foot?
- Do you have any flu-like symptoms?

Do not get the dressing wet

Getting the dressing wet may prevent healing or allow bacteria to enter the ulcer. This will cause more problems. Your podiatrist may be able to supply you with a dressing protector to keep the dressing dry, or they may give you a form to take to your GP to get a dressing protector on prescription. The dressing protector will allow you to have a bath or shower safely while keeping your dressing dry.

Moisturise the surrounding area of your feet

If your skin is dry, apply a moisturising cream every day, avoiding areas of broken skin and the areas between your toes.

Do not stand or walk on the affected foot

Avoid any unnecessary standing or walking. A wound cannot heal if it is constantly under pressure. Rest as much as possible and keep your foot up to help it to heal. Use anything your podiatrist recommends or gives you to relieve the pressure on your foot.

Footwear
You may be asked to wear a cast (a device to relieve pressure) or a temporary shoe until your ulcer has healed. You should not wear any other footwear until your podiatrist tells you that you can wear your own shoes again.
It is important that you wear these shoes at all times when indoors and outdoors to relieve pressure on your foot.

Podiatry appointments
Always attend your appointments to have your ulcer treated. You may need regular appointments until the wound has healed. Your appointment may be with a district nurse, a practice nurse, a treatment room nurse or your podiatrist.

Antibiotic treatment
You may be prescribed antibiotics if there are signs of infection in the wound or in the nearby tissue. Report any problems you have with the antibiotics (rashes, nausea or diarrhoea) to the person who prescribed them for you. If this person is not available, contact your GP immediately. Do not stop taking your antibiotics unless the person treating you or your GP tells you to do so. Make sure you have enough antibiotics to finish the course so your treatment isn’t interrupted.
If the infection is spreading, you may need to go to hospital. Here you would have antibiotics straight into your bloodstream to treat the infection quickly. This only happen

Operations
Sometimes, if an infection becomes severe, you may need a small operation to clean out the wound.
If an infection is very severe, an amputation may be needed to save healthy parts of the foot.
If your circulation is reduced, you may be referred for a small operation to increase blood supply to the ulcerated area.

If you discover any more problems, or if you are concerned about the treatment of your foot ulcer, contact your Multi-Disciplinary Foot Care Service, local Podiatry Department or GP for advice immediately.

Developed by the London Foot Care Strategic Clinical Network and the London Renal Strategic Clinical Network

Download this information in PDF

More foot care information at the links below

Charcot Feet

Footwear

Holiday feet

The National Kidney Federation cannot accept any responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.