This week I want to write on two very important circulatory diseases of the lower extremities… Arterial Ulcers and Venous Ulcers. I am writing this so you can be aware of these diseases should you ever see these problems in your legs or the legs of a loved one. Education of diseases of the extremities is very important because it provides you with more knowledge so you may recognize problems in a timely manner. This article is not meant to take the place of your physician’s help with your leg health.

An ulcer on the lower extremity is a break in the skin resulting in a wound. It is thought to be caused by a poor circulatory system. While, as a patient, it is not important for you to diagnose a venous ulcer or an arterial ulcer, it may be important for you simply to understand the difference between the two and to know what to do to keep from getting ulcers.

Arterial and Venous refers to origin of the ulcer. When a venous ulcer forms, the veins in the leg have become stretched and the valves have become incompetent and leak. This results in excess fluid in the tissues of the lower extremity and slows down oxygen and nutrients being transferred to the tissue so the skin can perform one of its most important functions, that of repairing itself.

Venous insufficiency is high blood pressure of the deep and superficial veins of your lower extremities! It is not the venous insuffiency or high pressure in the vein or veins that causes the venous ulceration, but the most likely cause of the venous ulceration is that there was a thrombus or a clot in the veins of the leg at some time. That clot becomes encased in plaque, the body thinks the ulceration has been healed and does not work to continue restoring normal tissue. The end result is tissue begins to die.

Venous Ulcer

Venous Ulcer

Venous Ulcer

  • For lower extremity edema you should elevate the legs and discourage rubbing, picking, pulling or scratching of the skin.
  • If the legs are not elevated, the edema may get so bad the fluid will not have anywhere to go and will seem to come out of every available hole – even out of the pores of the skin themselves.
  • The legs may even look as if they will pop if you blow on them, then the next day they are weeping copiously.
  • The next thing that happens is the skin starts to come off in patches and pretty soon…you guessed it, voilà a venous ulceration.

Arterial ulcers are caused, basically, not by the veins failing to remove excess fluid, but by the arteries failing to supply enough oxygen and nutrients to keep the tissues alive.
Arterial wounds are generally more difficult to treat and often more painful, particularly when lying down (e.g. in bed at night).

Often the primary diagnosis of an Arterial Ulcer is Peripheral Arterial Disease (PAD). This diagnosis is not a diagnosis to be taken lightly and needs skilled and consistent care to avoid severe complications.

PAD does not necessarily result in the arterial ulcer, but occurrence of an ulcer on the lower extremity is a risk factor in the diagnosis of PAD. The older a person becomes, the easier it is to have a small injury (just a scrape, a bump) and because the arterial circulation itself is already compromised, the area never heals properly. A hard substance called plaque forms at the site of the injury and the body thinks it has healed the wound. Now, people normally will bump their thigh and get a bruise, but the injury is not always the site where the ulcer forms, but rather below the area of the injury. The lower extremity is already compromised, you get hurt above the feet or ankle, plaque encases that injury which decreases the circulation even further. The artery is now moving even less oxygen and nutrients to the lower extremity and the tissue begins to die. That is harsh, but there is no better way to put it. It isn’t that I want to frighten you, but to keep on instructing you in what to do to prevent this from happening if at all possible!

arterialulcer

Arterial Ulcer

With arterial insufficiency you must never elevate the leg. With arterial insufficiency compression is usually not used. This is totally opposite for Venous Ulcers.

Arterial Ulcer

  • When Arterial Ulcers are present skin is pale, shine, taut, and thin
  • Swelling is not usually noted when arterial ulcers are present.
  • The legs should not be elevated with arterial ulcers. In fact the legs feel better when they are down.
Arterial Ulcer
  • May be found on tips of toes, between the toes or on the outside (lateral side) of ankles
  • Most likely are perfectly round, smooth edges
  • May or may not have swelling (edema) of the lower extremities
  • Lower extremity may be cool to touch, skin is pale shine, taut, and thin
  • Minimal drainage
  • No odor
  • Skin on lower extremities often tight, hard, shiny
  • Skin is often cool or cold to touch
  • There may not be any hair on the toes or on the legs
  • There may be pain with walking (claudication)
  • Faint to absent pedal (foot) pulse
Venous Ulcer
  • Found on the inside of the ankle (medial side), above the ankle bone
  • Shallow and Superficial
  • Can be small or large, but the edges are NOT A PERFECT CIRCLE
  • Almost always there will be edema (swelling of the leg) and in fact, edema is usually the FIRST thing you will find
  • Wet all the time, and depending on how long the patient legs are kept dangling will determine how much drainage there will be
  • May have an odor
  • Usually there is no pain with walking, per se, but the patient will say it hurts to stand up. Once they are up and start walking, the pain subsides

It is really surprising; I talk to many people that have never heard of support stockings or support socks. They have no idea that compression socks or compression stockings can make their legs feel better and keep venous insufficiency under control. My best advice is to wear them!! I do…every single day!

There is such a thing as having Venous Insufficiency and Arterial Insufficiency. In cases such as these, the physician may have the patient wear a light compression stocking or compression sock. Remember, your physician is your best source of information. We are here to educate you and assist him in his job so that you may have healthy legs.

                                                  

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