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.