Leg Ulcers

Aetiology

• Venous hypertension
• Arterial insufficiency
• Neuropathic (e.g. diabetes mellitus)
• Neoplastic (e.g. squamous cell carcinoma)
• Vasculitis
• Infection, e.g. syphilis
• Blood disorders, e.g. sickle cell disease
• Trauma

Venous ulcers

• Most common cause
• Associated with venous hypertension or previous thrombosis
• Often recurrent and chronic
• Usually painless
• Medial aspect of leg
• Exclude arterial insufficiency with Doppler

Management

• Topical therapy to ulcer
• Compression bandaging and elevation of legs
• Antibiotics for overt infection
• Diuretics for oedema
• Analgesia if painful
• Skin grafting if resistant to therapy

Arterial ulcers

• Punched out
• Painful
• Leg cold and pale
• Absent pulses
• History of hypertension, claudication, smoking, angina
• Investigate with Doppler studies/angiogram

Management

• Analgesia
• Topical treatment of ulcer
• Vascular reconstruction

Neuropathic ulcer

• Over pressure areas, e.g. metatarsal heads
• Result of trauma
• Polyneuropathy, e.g. diabetes mellitus
• Painless

Management

• Keep clean
• Avoid trauma including good foot care