Also known as ischemic ulcers are caused by insufficient blood flow through the artery. The most common cause is atherosclerosis but arterial ulcers can also be related to vasculitis, Raynaud’s Syndrome, sickle cell anemia and other diseases that can interrupt or hinder arterial blood flow.Location: Typically the toe area. However, they are also found over the distal part of the leg especially the outside ankle area and the top of the feet.
- Shallow or deep
- “Punched out” appearance – small and round with well-demarcated borders
- Wound base – pale and smooth
- Very painful
- Often has necrotic tissue presence (dead tissue that appears dark and leathery or soft tissue that is moist and yellow/creamy)
- Legs are more painful when elevated, less painful when hanging down
- Decreased pulses on the top of the foot and behind the ankle
- Lack of hair over the lower leg
- Skin around the wound may be bluish or very pale
These ulcers affect approximately 3.5% of people older than age 65 and account for approximately 70-90% of chronic leg ulcers. The recurrence rate is nearly 70% so once an individual has a venous ulcer, they will likely get another. . Venous ulcers develop because of poor blood flow in the veins in the legs. This insufficient blood flow can occur for a variety of reasons. The result is that the valves in the calves that open and shut when we walk to facilitate blood return to the heart are inefficient and therefore, the blood pools in the lower leg causing severe swelling in the extremity. This swelling applies pressure to the small vessles that feed blood to the skin which prevents healing.Location:30-40% of venous wounds occur above the inside ankle with the remainder forming in the lower one-third of the calf.
- Wound bed appears ruddy or beefy red
- Wound edges are flat and irregular in shape
- Drainage is moderate to heavy depending on the amount of swelling
- The shin area of the leg is often stained a brownish red color
- Pain varies from no pain to severe pain. If pain is present it is generally greater with leg(s) dependent, less when elevated
Diabetes affects nearly 16 million Americans and is the single most common underlying cause of foot or leg amputations. This is because diabetes is not just a disease of the pancreas. Diabetes eventually affects all body systems including circulation, nutrition, sensation, and numerous others. One of these affects is a sensory deficit called neuropathy. This is a deterioration of the nerves in the legs and feet which produces numbness, tingling, burning and other sensations. Many patients suffer from wounds caused by ill fitting shoes which have rubbed a blister or sore on the foot and the diabetic patient cannot feel the discomfort. Once the wound occurs, impaired circulation creates a significant disadvantage in the patient being able to heal due to a lack of blood flow to the wound. These wounds often become chronic and the longer a wound is present, the higher the risk of infection. Diabetic wounds are among some of the most complicated and difficult to heal. This is a very important reason to seek out a Curatio Solutions center to get started on an appropriate treatment plan early to minimize the risk of an eventual amputation.
Anywhere on the feet where rubbing occurs – between the toes, bottom of the foot, tips of the toes. They can also be found on the ankles, heels, and lower legs.
- Typically the wound margins will be even
- Typically the wound will be deeper rather than shallow
- The surrounding area may be inflamed and there may be infection in the bone
- Typically there will be low to moderate drainage
These wounds occur when an individual in is one position long enough to impede blood flow to skin tissue located over a bony prominence. When the blood flow stops to these areas the tissue dies and wounds occur. These wounds are typically preventable if debilitated patients are repositioned at least every two hours, incontinent patients are kept clean and dry, neuropathic patients wear shoes that fit properly, and patients eat well balanced meals that include adequate protein and keep diabetic blood sugar levels normal. Patients at highest risk for pressure ulcers are those with chronic illness that requires bed rest, dehydration, diabetes mellitus, decreased sensation or pain awareness, fractures, incontinence, malnutrition, paralysis or bedfast, poor circulation, obesity, and those who have had pressure ulcers previously.
Pressure ulcers present in many different stages and therefore listing characteristics is not practical. The best characteristic to know is that any wound located over a bony prominence and is on a high risk patient noted above is more than likely a pressure wound.