Overview
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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