By Gary M. White, MD

An arterial ulcer (AU) is an ulcer of the leg or foot that develops from arterial insufficiency.


The most common sites for these ulcers are the toe, heel, and lateral malleolus. The ulcer base is often pale compared with the red granulation tissue of a venous ulcer. Little or no bleeding occurs. Look also for atrophic skin, a decrease in hair, thickened nails, pallor on elevation, and rubor of dependency. Numbness, paresthesias, or unilaterally cold feet may occur. Peripheral pulses are weak or absent.


Prevention is the best approach. Avoid all prolonged pressure in one spot or trauma. Antifungal treatment should be instituted at the first sign of tinea infection. Avoid temperature extremes to the feet. Have the toenails cut regularly. Wear comfortable shoes. For the treatment of any ulceration, avoid all pressure. With purulent drainage, treat for infection. Local care may include daily cleansing followed by application of an ointment or synthetic dressing. Compression stockings are to be avoided. Healing may take months to a year. Surgery to revascularize the limb may be necessary.


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