At a Glance: Venous leg ulcer versus arterial leg

Venous leg ulcer
Venous leg ulcer

Venous leg ulcers
Clinical Features

  • Around 95 per cent of leg ulcers are venous.
  • Arterial supply to the leg is usually normal.
  • Varicose veins are often seen and brown and/or black staining of the skin or eczematous change around the ulcer.
  • Risk of secondary infection with pain, inflammation, purulent discharge and crusting.

Management

  • Exclude arterial problem with Doppler.
  • Advise to stop smoking. Treat underlying cause.
  • For purely venous ulcers, exercise, elevation at rest and compression bandages.
  • Careful cleansing and debridement of the ulcer.
  • Antibiotics such as flucloxacillin for infection.
  • Skin grafting for large or persistent ulcers.

Arterial ulcers
Clinical features

  • More common in the elderly.
  • Feet cold, bluish. Common on heels and toes.
  • Sharply defined with surrounding skin pale and shiny.
  • Peripheral pulses reduced.
  • Pain on exercise and when the leg is elevated.

Management

  • Check that Doppler indicates arterial ulceration (<0.6).
  • Refer urgently if Doppler <0.5 or monophasic.
  • Retention bandaging only. Avoid tight clothing.
  • Treat with systemic antibiotics if necessary.

Contributed by Dr Jean Watkins, a GP in Ringwood, Hampshire.

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