Jeri Lundgren

How can I tell whether a lower extremity wound is arterial, venous, peripheral neuropathy or diabetic?

The location and characteristics of the wound will help indicate whether the wound is arterial, venous, peripheral neuropathy or diabetic.

Arterial wounds are typically located on the toe tips or web spaces, phalangeal heads, lateral malleolus (outer ankle bone) or mid-tibial area (shin). Characteristically, the wounds tend to be circular, covered with dry eschar. If they are open, the wound bed is dull pink and smooth. Exudate tends to be none to minimal. Arterial wounds are often non-healing and are precipitated by minor trauma or pressure. 

Venous (stasis) wounds are typically located superior to the medial malleolus (inner ankle bone) in the gaiter sock area. However, in contrast to arterial wounds, venous wounds can be anywhere on the calf. Characteristically, venous wounds tend to have irregular wound edges and are superficial, with a ruddy red wound base with or without white fibrin plaques. Exudate tends to be moderate to heavy. 

Peripheral neuropathy wounds are typically on the plantar (bottom) of the foot, metatarsal head, phalangeal joints and heels. Peripheral neuropathy wounds often have callused edges. The wound bed is often pale pink and necrosis/eschar may be present. The wound margins are typically well defined and round. Exudate is usually small to moderate. Like arterial wounds, peripheral neuropathy wounds are precipitated by minor trauma or pressure. 

Diabetic residents are prone to both arterial insufficiency and peripheral neuropathy. Please note: Under the Patient-Driven Payment Model, a diabetic foot ulcer is one point under the NTA component and places the resident in the Special Care Low category for the nursing component.