clinical features

Last reviewed 01/2018

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: