Leg Ulcers

Question 1

Leg Ulcers Epidemiology

Answer 1

-Venous more common

Question 2

Leg Ulcers RFs

Answer 2

Venous
-Varicose veins, DVT, phlebitis, FHx

Arterial
-PAD RFs, CHD, stroke/TIA, DM

Question 3

Leg Ulcers Venous Presentation

Answer 3

• Usually around circumference of lower leg from mid-calf to just below malleoli
• Larger but shallower
• Oozes venous blood when handles
• Can present with associated cellulitis
• Medial malleoli

Question 4

Leg Ulcers Arterial Presentation

Answer 4

• Small deep lesions with well defined borders
• Develops over long period of time with little to no healing
• Most commonly occur distally at sites of trauma or pressure
• Often having PHx of claudication or critical limb ischaemia
• Limbs cold with reduced or absent pulses

Question 5

Leg Ulcers Neuropathic Presentation

Answer 5

• Punched out, with deep sinus

- Often under calluses or over pressure points

Question 6

Leg Ulcers Differentials

Answer 6

• Rheumatoid arthritis can produce vasculitis ulcer
• Systemic vasculitis
• Diabetic ulcer

Question 7

Leg Ulcers Investigations

Answer 7

• Dip urine for ?
• Bloods
• ABPI

Question 8

Leg Ulcers Referral

Answer 8

• If ABPI <0.8, refer
• If <0.5, refer urgently
• Refer if failure to respond after two weeks

Question 9

Leg Ulcers Management Venous

Answer 9

• Leg elevation and increased exercise
• Lifestyle changes
• Antibiotics if infection
• Multicomponent compression bandaging (ABPI must be >0.6)
• Treat concurrent varicose veins with surgery

Question 10

Leg Ulcers Arterial Management

Answer 10

• Management is to manage PAD
• Refer if critical limb ischaemia
• Lifestyle changes
• Medical: CV RF modification
• Surgical: angioplasty if extensive disease

Question 11

Leg Ulcers Neuropathic

Answer 11

• Control diabetes
• Specialist care
• Regular chiropody
• Treat infections