Canadian Medical Alliance for the Preservation of the Lower Extremity
Basic Information About Wounds
You'll see the words "ulceration,"
"ulcer," "wound," and "sore" used in
health care and throughout this website.
These words all have different origins and
subtle differences in meaning, but in common
medical usage, the terms "wound," "sore," "ulcer," and "ulceration," may all refer to a hole or opening in the skin. For the purposes of this website, these terms are used interchangeably.
The etymology of these words is interesting. "Ulcer" and "ulceration" are derived from the Latin "ulcus," and refer to an open sore that may be slow or difficult to heal. Ulcerations are often associated with degeneration and a disorganized healing pattern.
The origin of the word "wound" is from the Old English word "wund" and, preceding that, the Germanic "wunde." Typically the connotation of the word "wound" carries with it the suggestion of some degree of trauma--perhaps a cut or a blow--in the connotation of the word "wound." This is why you hear of a bullet wound or a knife wound, but you do not hear of a bullet ulcer or a knife ulcer.
The word "sore" may also be used to describe a hole in the foot, and its origin is from the Old English "sare" and its predecessor, the Germanic "sehr," meaning pain. This is why we use the word as an adjective ("It's sore") for the discomfort often associated with injuries and wounds.
That these words of disparate origins have converged to relatively common meaning is actually appropriate because most of these lesions have some degree of trauma--usually weight bearing pressure, sheer or friction--as part of the cause, and most have some degree of difficulty healing, often because of diabetes, circulation issues, age, or some other health issue, and often some degree of pain or discomfort.
Still, it is worth noting that there is a classification of wounds based on their primary causation.
The main types of wounds we'll discuss in this website are arterial ulcers, venous ulcers, neuropathic ulcers, pressure sores, and those with mixed causation.
Arterial ulcers are caused by a lack of blood flow coming from the heart to the legs, feet and toes. They may be caused by disease of the large vessels or small vessels.
Venous ulcers are caused by abnormal blood flow back to the heart. These are also known as "venous stasis" ulcers, and more simply as stasis ulcers. The word "stasis" comes from the Greek "stasis," meaning the postural position "standing" or "standing still," as in standing water. The definition is therefore doubly appropriate, as the ulcers are caused by venous blood standing still, not returning to the heart, and venous ulcers are commonly associated with long periods of standing, where the fluids accumulate and stagnate in the leg.
Pressure sores or ulcers are also known as decubitus ulcers. These are caused by constant pressure applied to a body part, as seen with bed-ridden people. The most common locations are the tail bone and the heel in the foot. The word decubitus is Latin for "decumbere," meaning 'to lie down,’
Neuropathic ulcers are caused by a loss of sensation in the foot, to the extent that small traumas to the foot go unnoticed, leading to degeneration of the skin.
The words "neuropathy" and "neuropathic" are derived from a combination of two words with Greek roots, "neuro-", from the Greek word for "nerve," and "-pathy," which comes from the Greek word "-patheia," meaning "suffering." Neuropathy is so important to the formation of wounds, that you'll see the word "neuropathy" and "neuropathic" continually throughout this website--in fact we have an entire webpage devoted to neuropathy. If you know nothing about neuropathy you might wish to read that next.
Neuropathic ulcers are sometimes known as "neurotrophic" ulcers or "trophic" ulcers. The word "neurotrophic," comes from "neuro"--Greek for nerve, and "trophic," from the Greek "trophikos," for nutrition. This alludes to the perceived state of malnutrition within the nerve. In many cases (certainly for neuropathy associated with vitamin deficiency, alcohol toxicity and diabetes), there is much truth to this description.
Neuropathic ulcers are also called "Mal perforans" ulcers. The words "mal perforans" are derived from combining two Latin words: "mal" from "malus," meaning "bad," and "perforare," meaning "to pierce." So, the ulcer is aptly being described as a "bad perforation" in the skin.
And sometimes neuropathic ulcers are simply called diabetic ulcers, as the vast majority of neuropathic ulcers are caused from diabetes.
These are the most common types of ulcers, but keep in mind, there may be overlap. Ulcers may be a result of more than one cause--such as a diabetic with both neuropathy and poor venous circulation or a patient with poor arterial flow combining with a pressure sore from being in a bed.
To learn more about these different sorts of ulcers, we've created a separate page for arterial ulcers, venous ulcers, neuropathic ulcers, pressure sores, and ulcers of miscellaneous other causes.
This page written by Dr. S A Schumacher
Podiatric Surgeon, Surrey, BC Canada
All clinical photographs are owned and provided
by Dr. S A Schumacher. They may be reproduced
for educational purposes with attribution to:
Dr. S A Schumacher, Surrey, BC Canada and a link
back to www.CanadianMAPLE.org.
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"Out of your vulnerabilities
will come your strength."