Diabetic Exam

Lower Limb Ulceration



  • 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.
Last updated on November 28th, 2019
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