Arterial Ulcers

Question 1

Define arterial ulcers.

Answer 1

Arterial ulcers are caused by ischaemia to the leg. The ulcers are painful and more painful on elevation. Patients often say the ulcers are painful enough to wake them up at night and that they obtain relief by lowering their leg over the side of the bed.

Question 2

Explain the aetiology/risk factors of arterial ulcers.

Answer 2

Smoking
Diabetes mellitus
Hypertension
Hyperlipidaemia
Strong family history of atherosclerotic disease
Male

Question 3

Summarise the epidemiology of arterial ulcers.

Answer 3

Arterial ulcers are more common in males and people who have risk factors. They occur where the blood supply is the worst.

Question 4

Recognise the presenting symptoms of arterial ulcers. Recognise the signs of arterial ulcers on physical examination.

Answer 4

Painful, especially on elevation
Deep, punched out, dry and often elliptical sore
Location: between toes, ball of foot, lateral malleolus and bony prominence
Cold, pale limbs
Poor capillary refill
Venous guttering
Absent or weak pulses
Atrophic skin changes

Question 5

Identify appropriate investigations for arterial ulcers and interpret the results.

Answer 5

Investigate for signs of atherosclerotic disease:
BM
FBC
Fasting lipids
Urinalysis
Biopsy
Buerger’s test: Blanching of the foot on elevation to 15 degrees