Foot Ulcers

Question 1

What investigations are needed to determine cause of an ulcer?

Answer 1

Fasting glucose/ HbA1c
ABPI (0.8= PVD) 
Duplex ultrasound (PVD and venous insufficiency) 
X-Ray (osteomyelitis)
Swabs (exclude infection)

Question 2

Characteristics of an arterial ulcer

Answer 2

Area of poor blood supply- toe, pre-tibial area
Small deep ulcer
Well defined
Punched out with a necrotic base
Assoc- weak pulses, cool pale skin, loss of skin hair, nail dystrophy

Question 3

Management of an arterial ulcer

Answer 3

Vascular reconstruction

Question 4

Characteristics of a venous ulcer

Answer 4

Gaiter region 
Mild pain 
Varicose veins 
Large superficial ulcer 
Exudative, granulating base 
Sloping edges 
Assoc- varicosities, oedema, venous eczema, lipodermatosclerosis, haemosiderin deposition (brown) 
Atrophie Blanche

Question 5

Management of a venous ulcer

Answer 5

Compression bandaging after arterial insufficiency excluded by an ABPI reading of more than 0.8

Question 6

Characteristics of a neuropathic ulcer

Answer 6

Pressure points eg. Metatarsal heads, soles, heel, toes (often under calluses)
Painless and associated with reduced sensation peripherally
Small deep ulcer
Well defined and punched out
Granulating base
Assoc- overlying hyperkeratosis, glove and stocking sensory loss

Question 7

Management of a neuropathic ulcer

Answer 7

Debridement
Appropriate footwear 
Regular repositioning
Foot checking advice 
Don’t walk bare foot

Question 8

Marjolins ulcer

Answer 8

SCC
Occurs at sites of chronic inflammation eg. Burns, osteomyelitis after 10-20 years
Mainly lower limb

Question 9

Pyoderma gangrenosum

Answer 9

Associated with IBD/ RA
Can occur at stoma sites
Erythematous nodules or pustules which ulcerate