Wounds of the lower extremity, such as chronic venous leg ulcers and diabetic foot ulcers, often have a severe impact on patients' quality of life. Symptoms may range from mild to debilitating, depending on the location of the injury and its severity. These types of wounds also affect a tremendous number of people because lower extremity wounds are estimated to occur in up to 13% of the United States population. The estimated annual cost of treating lower extremity wounds is at least $20 billion in the United States.¹

Specific Effects of Lower Extremity Wounds

These wounds can impact patients in a variety of ways and with a range of severity. An overview of some of the common effects of lower extremity wounds includes the following:

• Pain: The prevalence of pain in chronic wounds ranges from 48% to 81%, and between 19% and 46% of these patients report moderate to severe pain.² The pain can make it challenging to complete daily tasks. It can also interfere with sleep and cause anxiety and depression in patients when it is not managed adequately.³
• Limited mobility: Pain from these wounds can make it difficult to complete any type of physical activity, including engaging in paid employment, thus contributing to feelings of social isolation.⁴ Even daily tasks such as preparing meals, completing housework, and conducting personal hygiene tasks can be impossible for some of these patients.⁴
• Exudate or odor: Lower extremity wounds, and particularly chronic wounds, can be extremely difficult to manage. These wounds are often moderately to heavily exudating and malodorous. Many patients, in addition to being embarrassed by the characteristics of the wound, find that managing these symptoms and performing wound care, including frequent dressing changes, can be difficult and painful.³
• Psychosocial impacts: Many complications of these wounds can prolong healing time and continue to impact daily life for patients.⁵ Patients with chronic lower extremity wounds often experience a wide range of psychosocial effects, such as diminished confidence in their appearance, loss of dignity, and altered self-perception. These wounds frequently may also limit their desire for maintaining family, social, and professional relationships out of embarrassment about their physical limitations and wound symptoms, such as moderate to heavy exudate and odor.
• Complications: Lower extremity wounds can have complications, such as wound chronicity, infection, limb loss, and even death.
• Financial hardship: Caring for chronic lower extremity wounds can be extremely expensive. In addition to the actual cost of care, for younger, working patients, lower extremity wounds correlate with work absences, job loss, and a negative impact on finances. The combination of lost income and medical expenditures can lead to profound financial hardships for many patients.⁴

The reality is that lower extremity wounds are far more than the physical damage to the body. They often have widespread effects on nearly every aspect of a patient's life. For these reasons, health care providers may consider using advanced treatment modalities early on to optimize wound healing while minimizing the risk of recurrence or infection and preventing limb loss. Prevention and faster healing times are key in continuity of care.

Treatment Options for Lower Extremity Wounds

Standard wound care treatments include the following: wound bed preparation; moist wound healing; appropriate advanced wound care treatment options; one or more debridement methods, implemented as indicated; orthotics; and mobility improvement strategies. Occupational therapists can also work with these patients to overcome some of the challenges they face because of limited mobility.⁵ Other treatment modalities that can work in conjunction with each other to enhance wound healing may include surgical interventions, laser therapy, hyperbaric oxygen therapy, shockwave therapy, and electrical stimulation, among others.⁶ Utilizing various strategies together can improve the healing process for lower extremity wounds.

Pain Management

In addition to improving the healing environment of the wound itself, it is often crucial to employ proper pain management strategies. Pain perceptions can be linked to increased depression and anxiety. Health care providers must take the time to assess and appropriately treat the wound based on the patient’s report. Pain management programs can address specific types of pain.³ Types of pain include constant, intermittent, non-cyclical, cyclical, and/or chronic. When various treatment modalities are combined with proper pain management, overall quality of life for the patient is enhanced, and in many instances this approach can lead to optimized healing and better patient outcomes.

References

1. Star A. Differentiating lower extremity wounds: arterial, venous, neurotrophic. Semin Intervent Radiol. 2019;35(5):399-405.

2. Edwards H, Finlayson K, Skerman H, et. al. Identification of symptom clusters in patients with chronic venous leg ulcers. J Pain Symptom Manage. 2014;47(5):867-875.

3. Newbern S. Identifying pain and effects on quality of life from chronic wounds secondary to lower-extremity vascular disease: an integrative review. Adv Skin Wound Care. 2018;31(3):102-108.

4. Platsidaki E, Kouris A, Christodoulou C. Psychosocial aspects in patients with chronic leg ulcers. Wounds. 2017;29(10):306-310.

5. Sen, CK. Human wounds and its burden: an updated compendium of estimates [editorial]. Adv Wound Care (New Rochelle). 2019;8(2):39-48.

6. Feily A, Moeineddin F, Mehraban S. Physical modalities in the management of wounds. 2016. https://www.intechopen.com/books/wound-healing-new-insights-into-ancien…;