At a Glance

Arterial ischaemic vs neuropathic ulcers

Arterial ischaemic ulcers have a male predominance

Arterial ischaemic ulcers
Discriminatory signs

  • History of intermittent claudication, rest pain.
  • Diminished or absent pulses, pale when elevated, redness when dependent.
  • Increased capillary refill time.
  • Absence of hair, dystrophic nails.
  • Painful ulcers, which do not bleed.
  • Male predominance.
  • Multiple and punched-out over toes, foot and ankle.
  • Pale granulated tissue covered by necrotic slough.
  • Poorly epithelialised.
  • Leg not oedematous.


  • Smoking cessation advice.
  • Advise regarding exercise.
  • Manage associated risk factors such as diabetes and dyslipidaemia.
  • Measure the ankle/brachial systolic BP index.
  • Consider referral to tissue viability nurse.
  • Avoid compression bandage.


Arterial ischaemic ulcers have a male predominance

Neuropathic ulcer
Discriminatory signs

  • Painless.
  • Surrounded by callus.
  • Normal foot pulses.
  • Plantar aspect of foot.


  • Check for diabetes and other causes of peripheral neuropathy.
  • Give the patient foot care advice.
  • Consider referral to specialists, for example podiatrist to help with removal of excessive callus.
  • Relieve pressure from footwear or other precipitating cause.
  • Treat infection if present.

Text contributed by Dr Vasa Gnanapragasam, a GP in Sutton, Surrey.

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