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Diabetic Exam

Lower Limb Ulceration

November 28th, 2019


Ulcers, or non-healing open wounds, may occur in the lower limb in the context of arterial disease, venous disease or peripheral neuropathy.

Arterial Ulcers

The presence of white, painful ulcers suggests a partial or complete arterial occlusion.
  • Look For

  • Deep, painful white ulcers with blanched surrounding tissue, affecting the toes, heels and bony prominences. These ulcers may become black with necrosis.
  • Causes of Arterial Ulcers

  • Atherosclerosis
  • Diabetes
  • Thromboangiitis
  • Vasculitis

Venous Ulcers

Red, painless ulcers are suggestive of venous insufficiency.
  • Look For

  • Superficial painless red ulcers with moderate exudate, most commonly over the gaiter area (from mid-calf to 1cm below the malleoli)
  • Causes of Venous Ulcers

  • Venous hypertension due to incompetent valves
  • Venous outflow obstruction
  • Calf-muscle pump failure - obesity, immobility

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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