- 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
- 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