Ask the treatment expert: What are the most important things to know about lower-extremity ulcers?

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Q: I need to know more about lower extremity ulcers. Can you help?

A: Lower extremity ulcers can be confusing and complicated at times. To do the topic justice, in the coming months, I'll be offering a discussion of the three most common types of these ulcers to provide a deeper understanding.

Lower extremity ulcers affect millions of people in the United States, particularly individuals over the age of 60. Leg ulcers may be classified as acute or chronic. Acute ulcers usually heal in less than four weeks and follow the normal phases of healing. Chronic ulcers are more complex and take longer to heal. About 1% of the older population is affected by chronic leg ulcers.

Conditions that can cause leg ulcers include: diabetes, renal failure, poor circulation, venous insufficiency, lymphedema, inflammatory diseases, hypertension, smoking and obesity.

A comprehensive physical assessment of the lower extremities is needed to determine the type of ulcer. The circulatory assessment should include: color and temperature of feet and legs, assessment of capillary/venous refill, presence or absence of hair on feet and legs, condition of skin, edema, thickened nails and determination of ABI (Ankle-Brachial Index). The neurologic assessment should include: gait and balance, sensory and vibratory function, assessment of footwear and foot deformities. The wound assessment should include: location, appearance of wound base and edges, surrounding skin, dimensions, exudate, presence of undermining or sinus tracts and pain assessment.   The three most common types of lower extremity ulcers are:

• Venous Stasis
• Arterial (ischemic ulcers)
• Neuropathic (diabetic)  

Next month we will explore how to access and manage each type.