Distinguishing

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Arterial, Diabetic, & Vascular Ulcers

Arterial Ulcers Diabetic Ulcers Venous Ulcers

Predisposing Factors
• Peripheral vascular • Diabetic patient with • Valve incompetence
disease (PVD) peripheral neuropathy in perforating veins
• Diabetes mellitus • History of deep vein
• Advanced Age thrombophlebitis and
thrombosis
• Previous history of
ulcers
• Obesity
• Advanced age
Anatomic Location
• Between toes or tips • On plantar aspect of • On medial lower led
of toes foot and ankle
• Over phalangeal • Over metatarsal • On malleolar area
heads heads
• Around lateral • Under heel
malleolus
• At sites subjected to
trauma or rubbing of
footwear
Wound Characteristics
• Even wound margins • Even wound margins • Irregular wound
• Gangrene or necrosis • Deep wound bed margins
• Deep, pale wound • Cellulitis or underlying • Superficial wound
bed osteomyelitis • Ruddy, granular
• Blanched or purpuric • Granular tissue tissue
periwound tissue present unless PVD is • Usually no pain
• Severe pain present • Frequently moderate
• Cellulitis • Low to moderate to heavy exudate
• Minimal exudate drainage
Patient Assessment
• Thin, shinny, dry skin • Diminished or absent • Firm edema
• Hair loss on ankle & sensation in foot • Dilated superficial
foot • Foot deformities veins
• Thickened toenails • Palpable pulses • Dry, thin skin
• Pallor on elevation • Warm foot • Evidence of healed
and dependent rubor • Subcutaneous fat ulcers
• Cyanosis atrophy • Periwound and leg
• Decreased hyperpigmintation
temperature • Possible dermatitis
• Absent or diminished
pulses