Ulcer

Venous Ulcers: Venous ulcers form when the valves in leg veins are damaged, or the veins are dilated. This leads to venous hypertension, and as a result, edema and hemosiderin deposition. Venous ulcers tend to be irregularly shaped, have shallow margins, and contain granulation tissue or yellow fibrin. They are most often found between the medial malleolus and lower calf, due to the location of the great saphenous vein. Conditions that may predispose someone to venous ulcers are varicose veins, a previous deep-vein thrombosis, obesity and pregnancy. Treatments include compression therapy and leg elevation.

Arterial Ulcers: Arterial ulcers form when tissues are receiving impaired blood flow. This leads to reduced perfusion of the skin and soft tissues, resulting in ischemia and leg ulceration. A common etiology of arterial ulcers is peripheral vascular disease (secondary to atherosclerosis). They are most common among smokers, diabetics, and those with hyperlipidemia. The ulcer can be described as dry, “punched out”, deep, and with well-demarcated edges. The base will likely be pale, non-granulating, and necrotic. Commonly affected areas are the lateral malleolus, toes, and feet. Physical exam findings include shiny skin, reduced pedal hair growth, cool skin, and absent or weak pulses.


Neuropathic Ulcers: Neuropathic ulcers form due to a loss of protective sensation. This is common in diabetics following physical trauma that goes undetected. In addition, inadequate perfusion of the foot leads to dry skin that can become easily injured by repetitive microtrauma. Another cause of neuropathic ulcers comes from autonomic neuropathy that leads to foot deformities. Neuropathic ulcers are deep and surrounded by callus. A common treatment is to off-load the pressure at the ulcer site to allow time for healing.

---

Singer, A. J., Tassiopoulos, A., & Kirsner, R. S. (2017). Evaluation and Management of Lower-Extremity Ulcers. New England Journal of Medicine, 377(16), 1559–1567. doi:10.1056/nejmra1615243