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Lower Extremity Ulcers: Recognize the Symptoms… Get Treatment!

What is an ulcer?

Lower extremity ulcers (those in the leg and foot) are open and/or non-healing wounds or sores. Ulcers usually do not heal on their own or with standard home remedies. In some patients, they may temporarily recede, only to come back over and over.

Lower extremity ulcers are quite common in patients with peripheral arterial disease (PAD) due to the lack of circulation in the legs and feet. Ulcers may be painful. They are typically accompanied by discoloration, swelling, rash, scaly or shiny skin, redness, warmth, and burning or itching sensation.

What causes leg and foot ulcers?

Most foot and leg ulcers are caused by lack of healthy blood flow and/or loss of sensation/nerve damage in the extremities. These conditions, in turn, are commonly caused by type 2 diabetes and peripheral arterial disease. You can learn more below about three of the most common types of lower extremity ulcers, including ulcers caused by peripheral arterial disease.

Venous Stasis Ulcer

Venous stasis ulcers usually develop below the knee, especially on the inner part of the leg just above the ankle. About 80 to 80 percent of all leg ulcers are venous stasis ulcers. The base of the ulcer is usually red; it may have a yellow fibrous tissue covering it. Fluid drainage is normal. Discharge is possible if the ulcer is infected. The border of a venous stasis ulcer is often irregularly shaped, causing the surrounding skin to become discolored, swollen, shiny, tight, and warm or hot. These ulcers are common in patients with varicose veins.

Arterial (Ischemic) Ulcer

Arterial ulcers, also called “ischemic ulcers,” are the kind that patients with peripheral arterial disease should be especially concerned about. Arterial ulcers are usually caused by poor circulation in the arteries, which carry blood away from the heart and – in the case of patients with PAD – are partially or completely blocked with plaque buildup. Usually, patients with arterial ulcers are aware that they have PAD. However, if you haven’t been getting regular medical care, then it is possible that you could have an arterial ulcer without being aware of your high-risk for (or development of) PAD.

These types of ulcers usually have a brown, yellow, black, or grey color; they typically do not bleed. The border of the arterial ulcer may have a “punched out” look. You may find that lowering your leg causes the skin to become reddish, while elevating the leg drains the color from the surrounding skin. These ulcers can be especially painful at night; many patients hang their leg or foot off the bed in order to get pain relief.

Neurotrophic (Diabetic) Ulcer

Though neurotrophic ulcers are usually referred to as “diabetic ulcers,” don’t let the phrase lead you to believe that only patients with diabetes are susceptible. Rather, these ulcers can occur in anyone with neuropathy (nerve damage/loss of sensation) in the foot. Also, many patients with PAD could have undiagnosed type 2 diabetes.

The base of neurotrophic ulcers can vary in appearance, depending on the quality of your circulation. Color can range between pinkish red and brownish black. The border of the ulcer usually has a punched out appearance; surrounding skin is often calloused.

How are ulcers treated?

If you have – or think you may have – an ulcer on your leg or foot, it’s important to let your physician know immediately. Untreated ulcers can lead to infection, disease, limb amputation, and – in some cases – even death.

Ulcers may be treated with hyperbaric oxygen therapy, antibiotics, compression techniques, and other advanced methods (available through St. Luke’s Medical Center). It is equally important to treat the underlying cause of the ulcer, which in many cases is peripheral arterial disease.

Could your foot or leg ulcer be related to PAD?

If you’ve been diagnosed with peripheral arterial disease, your physician at Advanced Heart and Vascular Institute will go over ulcer prevention with you during your appointment. Follow your physician’s instructions, and – again – always let your doctor know about an ulcer. For evaluation and treatment, contact Advanced Heart and Vascular Institute (Mesa, Globe, and Tempe, AZ) at 602-507-6002.

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