Different Types of Leg Ulcers (Differentiating from Venous Leg Ulcers)

• Arterial leg ulcers
o Caused by insufficient arterial blood supply to the lower limb, resulting in ischemia and necrosis.
o A vascular assessment is required to establish the location and extent of the occlusion and presence of small vessel disease.
o The client may require angioplasty or major vascular surgery.
• Rheumatoid ulcers
o Described as deep, well demarcated and punched-out in appearance.
o Persons with rheumatoid arthritis may develop vasculitis, which causes occlusion of small vessels leading to tissue ischemia.
o Ulcers resulting from vasculitis tend to have a purplish hue around the edges.
• Diabetic ulcers
o Usually found on the foot, often over bony prominences such as the bunion area or under the metatarsal heads and usually have a sloughy or necrotic appearance.
o An ulcer in a diabetic client may have neuropathic, arterial and/or venous components.
o It is essential to identify the underlying etiology.
o The Doppler measurement of the ABPI may be unreliable in the diabetic client if calcification prevents compression of the artery.
o Specialist assessment is required.
• Malignancy is a rare cause of ulceration, and more rarely, a consequence of chronic ulceration.
o Ulcers with atypical site and appearance such as rolled edges, or non-healing ulcers with a raised ulcer bed should be referred for biopsy.