Arterial Ulcer: Symptoms, Causes & Treatment

An arterial ulcer is a skin wound that develops when blood circulation to the area is reduced. It can cause round, deep, painful sores that do not heal over time.

Arterial ulcers may also grow larger or become infected. They are also known as ischemic ulcers.

This type of ulcer can appear on the feet, ankles, or legs. It is usually caused by artery blockage due to fatty plaque buildup, called atherosclerosis.

Main symptoms

The main signs and symptoms of an arterial ulcer include:

• A round wound that gradually increases in size

• A deep wound that usually does not bleed

• Regular, well-defined, often whitish wound edges

• Cold, thin, dry, and shiny skin around the wound

• Pain at the wound site, especially when walking or at night when lying down

• Pain that may persist even at rest but improves when the foot is lowered over the side of the bed

• A wound base that may appear yellow, gray, brown, or black

• Lack of hair growth on the skin in the affected area

• Thickened toenails

In addition, an arterial ulcer may have pus, drainage, or a strong odor if it becomes infected.

Arterial ulcers are more common on the tips of the toes, between the toes, on the sides of the feet, on the heel, on the outer ankle, or on the lower leg. According to the CDC, peripheral arterial disease is usually caused by fatty plaque buildup in the arteries, which can reduce blood flow to the legs and contribute to slow-healing wounds or ulcers.

It is important to see a primary care provider, dermatologist, or vascular specialist if symptoms are present, so the arterial ulcer can be diagnosed and treated promptly to prevent complications such as necrosis or gangrene.

Arterial ulcer vs venous ulcer

Both arterial ulcers and venous ulcers cause skin wounds, but they have different causes and characteristics.

An arterial ulcer is caused by blockage of the arteries in the legs due to fatty plaque buildup. A venous ulcer is caused by poor blood circulation that makes it harder for blood to return from the legs to the heart, causing blood to pool in the legs.

Venous wounds are more common in older adults, people who stand for long periods, or people with chronic venous insufficiency. Arterial ulcers are more common in people with reduced arterial circulation, such as those with diabetes, excess weight, or high cholesterol.

Arterial ulcer wounds are usually deeper, have regular edges, cause intense pain that worsens when the leg is elevated, and the skin is usually cold. Venous ulcer wounds are usually more superficial, have irregular edges and swelling, and the pain may improve when the legs are elevated.

Confirming a diagnosis

The diagnosis of an arterial ulcer is made by a dermatologist, primary care provider, or vascular specialist through an evaluation of symptoms, health history, wound characteristics, pain, and signs of infection.

The doctor may also order tests to assess blood flow, such as an ankle-brachial index (ABI) test or Doppler ultrasound.

Blood tests, such as a complete blood count (CBC), coagulation tests, cholesterol levels, and blood glucose levels, may also be ordered to check for infection, clotting problems, and underlying conditions that can affect circulation or wound healing.

Possible causes

An arterial ulcer is caused by reduced blood flow, oxygen, and nutrients to the legs or feet, which can lead to skin cell death and the development of symptoms.

According to the CDC, peripheral arterial disease is usually caused by fatty plaque buildup in the arteries, which can reduce blood flow to the legs and contribute to slow-healing wounds or ulcers.

Risk factors

Risk factors for the development of an arterial ulcer include:

• Atherosclerosis

• High cholesterol

• Uncontrolled diabetes

• High blood pressure

• Obesity

• Peripheral neuropathy

• Vasculitis

• Thromboangiitis

• Sickle cell anemia

• Pyoderma gangrenosum

• Thalassemia

• Family history of vascular disease

• Smoking

According to the American Heart Association, smoking, diabetes, high blood pressure, and high cholesterol are key risk factors for peripheral artery disease, which can reduce blood flow to the legs and feet.

In addition, arterial ulcers can develop due to foot deformities or wearing improper shoes, which can increase pressure on certain areas of the foot and reduce blood flow.

Treatment options

Treatment for arterial ulcers should be guided by a primary care provider and a vascular specialist. The goal is to improve blood circulation to the area, support skin healing, and prevent wound infections.

The main treatments that may be recommended by the doctor are:

1. Wound cleaning

Wound cleaning should be done with saline solution, according to the doctor’s instructions. It is often performed by a nurse in a hospital or health clinic to ensure proper cleaning and regular wound monitoring, which helps prevent the ulcer from getting worse.

After cleaning the wound, ointments may be used to help the skin heal and prevent or treat infections. These may include silver sulfadiazine or collagenase, which should only be used as prescribed by the doctor.

2. Dressings

Some special dressings, such as crystalline cellulose dressings, may be recommended by the doctor to help speed up skin healing and prevent infections.

Arterial ulcer dressings should always be selected by a doctor or nurse. They should be adapted to the type of tissue in the wound and other characteristics, such as drainage, odor, or signs of infection, to promote proper healing.

3. Debridement

Debridement is a procedure used to remove dead and infected tissue from the ulcer. This helps improve healing and prevents the infection from spreading to other areas of the body.

This treatment is performed by a doctor in a hospital setting or by a nurse specialized in wound care, using local anesthesia.

4. Medications

Some medications may be prescribed by the doctor to treat arterial ulcer, such as antibiotics for wound infections, antiplatelet medications, or vasodilators to improve blood circulation.

The doctor may also recommend medications to relieve pain and control conditions that can cause arterial ulcers, such as diabetes, high cholesterol, or high blood pressure.

5. Angioplasty

Angioplasty is a procedure performed by a vascular surgeon to open a blocked artery and restore blood flow to the legs and skin.

In some cases, a stent may be placed in the artery. A stent is a small metal or polymer mesh tube that works like a scaffold to support the artery, help prevent it from narrowing again, and keep it open to improve blood flow.

Care measures

Some daily care measures are important during arterial ulcer treatment, such as:

• Taking medications at the times prescribed by your doctor

• Cleaning the wound at home as instructed, or having it cleaned by a nurse at a health clinic

• Drinking plenty of fluids throughout the day

• Not smoking

• Following a healthy diet and avoiding fatty or fried foods

• Avoiding crossing your legs during the day

• Walking for about 30 minutes a day to improve blood circulation in the legs

The wound cannot heal properly until circulation in the area improves. For this reason, it is essential to follow medical recommendations to restore blood flow and oxygen supply to the skin, as well as to treat any conditions associated with the arterial ulcer.

Possible complications

An arterial ulcer can lead to complications such as wound infection, tissue death (necrosis), or gangrene.

To reduce this risk, it is important to see a doctor as soon as symptoms appear so that appropriate treatment can begin right away.