Venous vs Arterial

CAUSES OF LEG/FOOT ULCERS:
VEIN PROBLEM or ARTERIAL PROBLEM?

Poor-healing wounds of the legs and feet are frequently caused by vein problems, arterial problems, and diabetes. Vein problems cause most of the ulcers on the legs treated in wound care centers by our laser expert. These wounds are called “venous leg ulcers”, because they are located in the middle or lower part of the leg, usually above the ankle. These ulcers may be quite large (5-10 cm diameter) and may be “ugly” in appearance, but they are usually not painful. If there is associated pain, the pain is frequently relieved by elevation of the extremity. The skin around these ulcers may be brownish in color and may be firm to touch (not soft and supple), for many years before the ulcer begins. A common cause of leg ulcers is reflux (abnormal blood flow) in the veins of the leg, specifically the saphenous vein. This problem can be treated permanently by the physicians (laser expert ) at Novant Health Vein Specialists with an out-patient procedure done in the office. Otherwise, venous leg ulcers tend to recur over time, especially if an appropriate treatment regimen with compression hose has not been followed. With venous leg ulcers, the risk of limb loss is low.

Arterial ulcers, on the other hand, are usually very painful. They are most often located in the foot or toes, i.e. further from the blood flow pump (the heart). Pain is the primary complaint for these patients, especially pain at night if their foot is not kept below the heart. In fact, many patients tell us they sleep with the foot hanging off the bed, to relieve their pain. The wound itself may be small (1-2 cm diameter), and is usually dry. For example, it may be just the tip of a toe. These wounds do not often look as “ugly” as a venous leg ulcer, because there is not enough blood flow to make pus or drainage. The skin around the wound is sometimes red, tender, and swollen, because bacteria can get though the skin and invade the surrounding tissues. This problem needs urgent treatment, and the risk of limb loss is high.

Diabetes patients also frequently get ulcers of the foot and toes, but that is primarily because of poor sensation (numbness) of the feet. The technical term for this numbness is “peripheral neuropathy.” Many of these patients also have arterial problems, with resultant poor arterial blood flow. This group of patients is at especially high risk of limb loss.

The physicians at SVSS are, in a broad sense, experts in the field of vascular disease. Therefore, they and are best qualified to determine the cause of a leg/foot ulcer, and will initiate a treatment plan that is best for you.

 

Characteristics

venousulcer

* Shallow
* Superficial
* Irregular shape
* Small to large
* Painful related to edema, phlebitis, or infection
* Usually appear on the lower leg and ankle
* Frequently the individual develops contact dermatitis
* Hemosiderin staining
* Lipodermatosclerosis
Risk Factors

* Deep vein thrombosis (link to dvt page)
* Congrestive heart failure
* Varicose veins
* Incompetent valves
* Any condition resulting in muscle
weakness in the lower extremities
* Malnutrition
* Obesity
* Immobility
* Pregnancy

Characteristics
arterialulcer * Full thickness wound
* Punched out appearance
* Wound edges are smooth
* Individual may complain of pain nocturnally: pain can be relieved by lowering the leg below heart level (i.e. dangling leg over edge of the bed).
* Individuals prefer to sleep in a chair which impacts negatively on healing potential
* Obesity Located mainly on the lateral foot, but can occur anywhere on the lower leg foot
* Lower extremities cool to touch
Skin is pale, shiny, taut and thin
* Periwound skin pale
* Minimal to no hair
* Growth on the lower limbs
* Minimal drainage
* Wound bed contains bright red granulation tissue
* May be secondary to peripheral arterial disease

Risk Factors

* Vascular insufficiency
* Uncontrolled Diabetes Mellitus with poor
glycemic control
* Limited joint mobility
* Inadequate footwear
* Structural foot abnormality, ie. Charcot foot
* Retinopathy (poor eye sight)
* Renal Disease
* History of ulcers
* Increased age