Vascular Skin Changes of the Leg
On this page:Pallor of the Lower LimbLower Limb ErythemaVenous Skin ChangesArterial Skin ChangesNeuropathic Ulcers
Overview
Skin changes and overall poor skin condition of the lower limb may occur due to soft tissue disease; arterial, venous or lymphatic insufficiency; loss of afferent nerve supply or simply poor self-care.
Pallor of the Lower Limb
Look For
- Loss of colour in one or both lower limbs.
Causes of Lower Limb Pallor
- Peripheral vascular disease
- Compartment syndrome
- Low cardiac output, due to cardiac disease
- Peripheral shutdown, due to increased sympathetic activity
Lower Limb Erythema
Look For
- Redness - unilateral, bilateral, localised or diffuse.
Causes of Lower Limb Erythema
- Dermatosis
- Infection - cellulitis, lymphangitis, necrotising fasciitis
- Vascular - deep venous thrombosis, superficial thrombophlebitis, venous insufficiency
- Lipodermatosclerosis (fibrosis of subcutaneous fat)
- Lymphoedema
Venous Skin Changes
Look For
- Oedema
- Venous eczema
- Hyperpigmentation
- White scar tissue (atrophie blanche)
- Induration - fibrosis of subcutaneous fat (lipodermatosclerosis)
- Ulceration - red, painless ulcers with moderate exudate, most commonly over the gait area (from mid-calf to 1cm below the malleoli)
Significance
- Venous insufficiency.
Causes of Venous Skin Changes
- Venous insufficiency
- Venous outflow obstruction
- Calf-muscle pump failure - obesity, immobility
Arterial Skin Changes
Look For
- Absent pedal pulses
- Thin / shiny skin
- Cool skin
- Hair loss
- Ulceration - white, painful ulcers with blanched surrounding tissue; may become black with necrosis
Significance
- Partial or complete arterial occlusion.
Causes of Arterial Skin Changes
- Atherosclerosis
- Diabetes
- Thromboangiitis
- Vasculitis
Neuropathic Ulcers
Neuropathic ulcers occur due any cause of sensory loss to the foot, resulting in greater likelihood of damage and unawareness of injury.
Look For
- Deep ulcers surrounded by callus, most commonly on weight bearing areas such as the sole of the foot. Associated with diminished sensation of the foot and normal pedal pulses.
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