Differential Diagnosis > Distribution > Lower Legs > Leg Ulcers

Leg Ulcers

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(most common to less common)

•venous stasis
•arterial disease
•neurotropic
•sickle cell ulcer lower legs, moderate pain, often "punched out"
•hypertensive
•hydroxyurea can cause severe painful leg ulcers (discontinuation heals)

 

see also Wound Healing

 

 

Venous stasis ulcers:

•location – medial ankle or lower calf
•symptoms – painless or mild
•characteristics – red base of granulation tissue; surrounding hyperpigmentation; depth: shallow; warm feet
•Venous disease: dermatitis and pitting edema
•see also Venous Stasis spectrum

 

Arterial ulcers (due to large vessels):

•location – usually toes or foot;  lateral aspect of ankle
•symptoms – severe pain
•characteristics – black or gray base;  no granulation tissue; depth: deep;  cold feet
•cause – arteriosclerosis obliterans, thromboangiitis obliterans
•Arterial disease: shiny, dry, atrophic surface with heel and toe fat pad diminution  

 

Neurotropic ulcers:

•location – over metatarsal arch, heel, toes
•symptoms – no pain
•characteristics – deep and surrounded by callus
•cause – diabetes and other neuropathies

 

Hypertensive ulcers:

•lateral and posterior calf;  severe pain
•black eschar surrounded by purpura
•etiology unknown