Step 3: Inspect the ulcer

It’s also important to inspect the ulcer and note the border, depth, and location. A
quick trick to watch for is that arterial and diabetic ulcers look alike and occur in
tandem, but venous ulcers are usually identified by clinical examination. 

Figure 1.  The steps for evaluating a foot or leg ulcer include, 1) check pedal pulses, 2) ask if the wound is
painful, and 3) inspect the ulcer.

Now, let’s get into more detail on how to differentiate between the three types of ulcers.

Signs and symptoms of arterial ulcers

Typically, arterial ulcers are extremely painful. However, it’s important to remember
that patients who also experience peripheral neuropathy may not feel them at all. 

Chronic arterial ulcers look like deep, round hole punches with regular, well-defined,
raised borders. The area around the ulcer will feel dry and cold and the skin may
be cracked. The pedal pulses will be weak or absent. 

Arterial ulcers are mostly located on the toes, between the toes, around the lateral
ankle, or on the tibia. Severe late-stage arterial ulcers can present as gangrenous
chronic limb ischemia (CLI) involving the toes. 

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