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Assessment and Management of Venous Leg Ulcers
The literature also stresses the importance of clear and comprehensive documentation of
information during history taking, and suggests several examples of leg ulcer assessment
forms. The RNAO guideline development panel does not consider one assessment form to
be superior to another. (For examples of leg ulcer assessment forms, see Appendices D and E).
Recommendation • 4
Examine both legs and record the presence/absence of the following to aid in the
assessment of underlying etiology.
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Venous Disease
usually shallow moist ulcers
situated on the gaiter area of the leg
edema
eczema
ankle flare
lipodermatosclerosis
varicose veins
hyperpigmentation
atrophie blanche
Arterial Disease
ulcers with a “punched out” appearance
base of wound poorly perfused, pale, dry
cold legs/feet (in a warm environment)
shiny, taut skin
dependent rubor
pale or blue feet
gangrenous toes
(Level of Evidence = C – RNAO Consensus Panel, 2004)
Discussion of Evidence:
Research strongly recommends that the person conducting the assessment should be aware
that ulcers may result from many different causes, such as arterial insufficiencies, diabetes,
rheumatoid arthritis, or malignancy. Where there is mixed venous/arterial etiology, this
condition will have the features of venous ulcer in combination with signs of arterial
impairment (RCN, 1998).
Several studies confirm that malignancy can cause and may be a sequel of leg ulceration
(NZGG, 1999). The RNAO guideline development panel supports the practice of checking for a