What are lower extremity ulcers?
Lower extremity ulcers are stasis ulcers if they are the result of pooling of the blood in the veins as can happen with varicose veins (Venous ulcers), or blockage of circulation in the legs as in peripheral artery disease (arterial ulcers) and nerve damage due to diabetes (Diabetic neuropathy). They are usually open sores that do not heal.
What causes leg ulcers?
The most common cause of lower extremity ulceration is vascular disease, and is most often due to chronic vein disease including varicose veins, deep vein thrombus and trauma.
Venous ulcers affect about 1% of the population. It has recently been reported that 85% of the lower extremity ulcerations are venous ulcers. Chronic vein disease is serious and debilitating, and 75% of the time, these ulcers reoccur. They are painful, open ulcers that can persist for weeks to months or years.
15% of lower extremity ulcers are caused by poor circulation (Peripheral artery disease caused by atherosclerosis), nerve damage (diabetic neuropathy) and some systemic diseases.
Types of lower extremity ulcerations
Vascular ulcers: The elderly and women are affected most often. Older age, obesity, previous leg injury, deep vein thrombus, varicose veins and phlebitis are the primary risk factors.
Neuropathic ulcers: Affect people with diabetes, typically uncontrolled blood sugar levels
Arterial ulcers: Affect people with poor circulation due to Peripheral artery disease (PAD)
Diagnosis
Leg ulcers are diagnosed based on the ulcer’s appearance, location and its borders as well as the appearance of the surrounding skin.
- Venous ulcers are able to be diagnosed by their location and appearance by a vascular surgeon, who specializes in lower extremity ulceration. Tests include ultrasound and tests to measure blood flow and pressure in the leg veins. They are usually located in the lower third of the leg and show inflammation or redness around the ulcer. They cause a dull ache or pain, swelling that subsides on elevation, and skin changes. These ulcers are shallow and irregular in shape.
- Diabetic foot ulcers are caused by nerve damage (neuropathy). This results in ulcers at pressure points on the bottom of the feet, and impaired sensation in the feet causing tingling, numbness and burning pain, as well as repeated injury. Tests include the ankle/brachial test, ultrasound and tests to measure blood flow.
- Arterial Ulcers due to peripheral artery disease (PAD) are found on the heels, tips of the toes and between the toes. They appear punched out and there may be swelling. These open wounds are at risk for infection. Arterial ulcers are very painful, especially at night. In PAD, atherosclerotic plaque often called hardening of the arteries, causes arteries in the leg to narrow or become blocked, resulting in inadequate blood flow, which damages the tissues. If left untreated, the tissue dies causing gangrene that may result in amputation.
Treatment options
- Venous ulcers: Conservative treatment including leg elevation, compression therapy, and medication. Compression therapy is the standard of care for venous ulcers. Leg elevation can reduce edema, improve circulation in the affected leg and help the ulcer heal. Ulcers that are large, resistant to conservative measures and of prolonged duration may require surgical intervention.
- Diabetic ulcers: Treatment of the underlying diabetic condition and evaluation of circulation. Diabetics are at higher risk for atherosclerosis, peripheral vascular disease and heart disease. Diabetic ulcers are responsible for more hospitalizations than any other diabetes complication. And, in the U.S., diabetes is the main cause of lower leg amputation. 5% of diabetes patients develop foot ulcers every year, and 1% require amputation. Wound care, taking pressure off of the ulcer with special footwear, and debridement- removal of dead skin and tissue will help the ulcer heal. The goal is to prevent infection.
- The treatment of arterial ulcers is designed to restore blood flow to the legs. Lifestyle improvements: Improve physical activity, stop smoking and eating healthy. Surgical procedures may be necessary to restore blood flow to the affected limb.
The board-certified vascular surgeons at South Valley Vascular Associates are trained in the diagnosis and treatment of diseases of the vascular system. Almost one in four people harbor symptoms of vascular disease. Vascular surgeons prefer to see patients early in their vascular disease and manage medical and surgical aspects of peripheral vascular disease. All people with leg ulcers should be seen by a vascular surgeon. To avoid serious complications from vascular diseases ask your primary care doctor to refer you to South Valley Vascular Associates. We have the skills and expertise to help you. At our offices located in Visalia, Porterville and Hanford California, we offer care for diseases of the arteries, vein and lymph systems.
