Examination often shows the ulcers to have a punched out appearance with well demarcated borders and a pale, non-granulating, often necrotic base (1).
- ulcers are often multiple and commonly occur on both the dorsal and plantar aspects of the foot
- ulcers are typically found on the toes, the heels, and the anterior shin and extend over the malleoli (1)
Skin is cold and atrophic, and there may be loss of hair, nail dystrophy, prolonged capillary refill and calf muscle wasting of the limb in underlying atherosclerosis (2)
In contrast to venous leg ulcers, those due to arterial ischaemia are often extremely painful
- patient may complain that the pain interferes with sleep, and that is exacerbated by raising the leg
- pain may be alleviated by hanging the foot over the side of the bed or sleeping in a chair
- pain usually begins distal to the obstruction, moving proximally as ischaemia progresses (1,2)
Peripheral pulses may be decreased or absent and there may be a history of claudication
- when there is peripheral arterial disease, there maybe a delay of 10-15 seconds in returning of color when raising the leg to 45° for 1 minute, and dependent rubor (Buerger's test) (3)
Often patients may reveal a history of claudication
About half of arterial ulcers have a previous venous component; the ulcers are of mixed aetiology
Reference:
- (1) Grey JE, Harding KG, Enoch S. Venous and arterial leg ulcers. BMJ. 2006;332(7537):347-50.
- (2) Bazari H, Jaff MR, Mannstadt M, Yan S. Case 7-2007 - A 59-Year-Old Woman with Diabetic Renal Disease and Nonhealing Skin Ulcers. N Engl J Med 2007; 356:1049-1057
- (3) Hopf HW, Ueno C, Aslam R, Burnand K, Fife C, Grant L, Holloway A, Iafrati MD, Mani R, Misare B, Rosen N, Shapshak D, Slade JB, West J, Barbul A. Guidelines for the treatment of arterial insufficiency ulcers. Wound Rep Reg 2006; 14: 693-710