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Lower Limb Ulcers

⚠️ Article status: Temporary high-yield summary

  • This article will be fully reviewed, expanded, and referenced in due course
  • Current content focuses on core principles and exam-relevant concepts

This table provides a high-yield overview of the three main types of lower limb ulcers, to aid clinical differentiation.

For more detailed information, see the Varicose Veins and Venous Ulcers and Peripheral Arterial Disease (PAD) articles.

Feature Arterial ulcer Venous ulcer Neuropathic ulcer
Cause Ischaemia (usually PAD) Venous insufficiency Peripheral neuropathy (e.g. diabetes)
Location Pressure points / site of trauma:

  • Toes
  • Heel
  • Lateral malleolus
Gaiter region – above the medial malleolus Sites of pressure / repetitive trauma:

  • Plantar surface
  • Tips of toes
  • Over bony prominences (e.g. sole, metatarsal heads)
Appearance
  • Deep, punched-out appearance
  • Well-defined edges
  • Pale, necrotic base
  • Shallow ulcer
  • Irregular edges
  • Granulating / exudative base
  • Deep ulcer with surrounding callus
Associated features
  • Very painful
  • Features of PAD (e.g. intermittent claudication)
  • Cold, shiny, hairless skin
  • Reduced / absent pulse
  • Delayed capillary refill time
  • ABPI (<0.9)
  • Mild pain / aching
  • Features of venous insufficiency (e.g. varicose veins, venous eczema)
  • Reduced sensation (painless)
  • Features of peripheral neuropathy

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