Arterial ulcers are chronic wounds that develop when blood supply to an area of the body, typically the lower legs and feet, is insufficient. This lack of oxygen and nutrients impairs tissue healing. Without adequate blood flow, even minor injuries can progress into open sores. These wounds often require specialized care due to their underlying cause.
Understanding Arterial Ulcers
An arterial ulcer is an open sore that forms on the legs or feet due to peripheral artery disease (PAD). PAD involves the narrowing of arteries, which reduces blood flow to the extremities. Arteries carry oxygen-rich and nutrient-rich blood throughout the body, and when this supply is compromised, tissues can become damaged and form ulcers. These ulcers commonly appear on the toes, heels, outer ankle, or areas experiencing pressure from walking or footwear.
Identifying Arterial Ulcer Symptoms
Arterial ulcers often have a “punched-out” appearance, round or oval with well-defined, even borders. The wound base typically looks pale, yellow, brown, gray, or black, with minimal new tissue growth. Surrounding skin often appears shiny, thin, and dry, with noticeable hair loss. The affected limb may feel cool to the touch and have diminished or absent pulses.
Pain is a prominent symptom, often severe, especially during exercise, at rest, or at night. Elevating the leg can intensify this pain, while dangling it may offer temporary relief by allowing gravity to aid blood flow. Changes in skin color are also common; the limb may appear pale when elevated and turn red when dangled. Capillary refill, the time it takes for color to return to the skin after pressure is applied, may be delayed in the affected extremity.
Underlying Causes and Contributing Factors
Atherosclerosis is the primary medical condition leading to arterial ulcers. This disease involves plaque buildup—a mixture of fat, cholesterol, and other substances—on the inner walls of arteries. This accumulation causes arteries to narrow and harden, restricting blood flow. When atherosclerosis affects the arteries supplying the limbs, it manifests as peripheral artery disease (PAD).
Several contributing factors accelerate atherosclerosis and PAD, increasing ulcer risk:
Smoking is a significant risk factor, damaging blood vessels and constricting arteries, worsening circulation.
Diabetes mellitus can lead to poor circulation and nerve damage.
High blood pressure (hypertension) damages arterial walls over time.
High cholesterol (hyperlipidemia) contributes to plaque formation.
Advanced age and a family history of vascular disease also increase susceptibility.
Obesity and a sedentary lifestyle also contribute by promoting conditions like hypertension and diabetes.
Diagnosis and Treatment Approaches
Diagnosis involves a comprehensive assessment, including patient history and physical examination. Healthcare providers inspect the ulcer and surrounding skin for characteristic signs, assess pulses, and check skin temperature and hair distribution. A primary diagnostic tool is the ankle-brachial index (ABI), a non-invasive test comparing ankle and arm blood pressure to assess lower limb blood flow. Additional imaging tests, such as duplex ultrasound, visualize blood flow in arteries and veins, while angiography provides detailed images of arterial blockages.
Treatment focuses on improving blood flow to the affected limb and providing local wound care.
Improving Blood Flow
Lifestyle changes are recommended, including quitting smoking, managing blood pressure and cholesterol levels, and regular exercise. Medications may be prescribed to improve blood flow or manage underlying conditions like diabetes. For more severe blockages, revascularization procedures may be necessary. Angioplasty involves inserting a balloon to open narrowed arteries, sometimes with stent placement to keep the artery open. Bypass surgery creates a new path for blood flow around a blocked artery using a healthy blood vessel from another part of the body or a synthetic graft.
Local Wound Care
This involves debridement, the removal of dead or infected tissue to promote new tissue growth. Appropriate dressings are applied to keep the wound clean and manage moisture, as arterial ulcers typically require a dry environment to reduce infection risk. Infection control, often with systemic antibiotics, is important, especially if signs of infection are present. A multidisciplinary approach, involving various healthcare specialists, is often employed to create a tailored treatment plan that addresses both the ulcer and its underlying causes.