Ischaemic ulcer versus neuropathic ulcer

Ischaemic ulcer

Neuropathic ulcer
Neuropathic ulcer

Clinical features

  • Male predominance.
  • Mainly affects shins and dorsal aspect of feet.
  • Usually multiple and punched-out appearance.
  • Oedema is unusual.
  • Chronic ischaemic foot is dry, scaly with nail dystrophy and poor hair growth.
  • May have claudication.
  • Pallor on elevation of foot and rubor on dependency.


  • Measure the ankle/brachial systolic BP ratio.
  • Advice regarding smoking cessation and walking.
  • Refer to a vascular surgeon.
  • Review drug therapy, and check annually. Neuropathic ulcer

Clinical features

  • Painless ulcer in a warm foot.
  • Located on the sole of the foot, under the metatarsal heads and the ball of the foot.
  • A rim of callus around the punched-out ulcer.


  • Advice on foot care and footwear.
  • Exclude neuro-ischaemic ulcer.
  • Refer if debridement of callus is required.
  • Investigate for possible neuropathic causes of the ulcer.
  • Check every three to six months.

Dr Vasa Gnanapragasam, a GP in Sutton, Surrey 

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