Ask the treatment expert: What should I know about ischemic and diabetic ulcers?

Share this article:
What's the best way to prevent skin tears?
What's the best way to prevent skin tears?
Q: I need to increase my knowledge about lower extremity ulcers. Can you help?

A: This month we address arterial ulcers and neuropathic ulcers.

Arterial (ischemic ulcers)

Some of the risk factors that may contribute to development of these ulcers include atherosclerosis, hypertension, diabetes mellitus, smoking and dyslipidemia. 

These ulcers are characterized by intermittent claudication pain progressing to nocturnal pain and then to rest pain.

They're usually found on feet, heels or toes; have even wound margins; and are manifest by hair loss on the foot and leg. Other characteristics include: thin shiny skin, pale wound bed, pallor with elevation and rubor when in dependent position, weak or absent pulses, abnormal ABI, and possible black eschar. 

Management of arterial ulcers includes improving tissue perfusion. Aspirin, statins and other medications may be appropriate. Debridement is contraindicated in dry uninfected necrotic wounds but may be necessary if infection is present.

Neuropathic (diabetic ulcers)

The risk factors include diabetes, hypertension, smoking, spinal cord injury, family history, obesity, increased age, poor glucose control, male gender, bone deformity and limited joint mobility.

These ulcers are characterized by being located on the plantar aspect of the foot, metatarsal heads, heels, and sites of painless trauma or repetitive stress. Dry, cracked skin, decreased sensation, edema, muscle atrophy and burning tingling pain commonly are evident.

To manage these ulcers, reduce pressure and trauma: Heel elevation, offloading, and total contact casting may be appropriate. Glucose levels need to be controlled. Moist wound therapy is helpful. Affected individuals should be encouraged to wear white socks without seams and avoid trauma.
Share this article:

More in News

Large hepatitis outbreak reaches 47 cases, podiatry company denies ManorCare's charges

The number of people infected in an infamous North Dakota Hepatitis C outbreak has risen, state health officials say.

National Quality Forum supports quality measures in bill to standardize post-acute assessments

National Quality Forum supports quality measures in bill ...

The National Quality Forum has come out in strong support of a proposed standardized quality measures, such as skin integrity, across different types of post-acute care settings. Uniform assessments are ...

CMS changes mind on hospice drugs

The Centers for Medicaid & Medicare Services has revised guidance on authorization of hospice drugs for those under Medicare Advantage and Part D plans, according to a new memo.