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Assessment and Management of Venous Leg Ulcers
Appendix C: Different Types of Leg
Ulcers and Their Causes
Arterial leg ulcers are caused by insufficient arterial blood supply to the lower limb, resulting
in ischemia and necrosis. A vascular assessment is required to establish the location and
extent of the occlusion and presence of small vessel disease. The client may require angioplasty
or major vascular surgery.
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Rheumatoid ulcers are described as deep, well demarcated and punched-out in appearance.
Persons with rheumatoid arthritis may develop vasculitis, which causes occlusion of small
vessels leading to tissue ischemia. Ulcers resulting from vasculitis tend to have a purplish hue
around the edges.
Diabetic ulcers are usually found on the foot, often over bony prominences such as the
bunion area or under the metatarsal heads and usually have a sloughy or necrotic appearance.
An ulcer in a diabetic client may have neuropathic, arterial and/or venous components. It is
essential to identify underlying etiology. The Doppler measurement of the ABPI may be
unreliable in the diabetic client if calcification prevents compression of the artery. Therefore,
specialist assessment is required.
Malignancy is a rare cause of ulceration, and more rarely, a consequence of chronic ulceration.
Ulcers with atypical site and appearance such as rolled edges, or non-healing ulcers with a
raised ulcer bed should be referred for biopsy.
Reprinted with permission.
Ottawa-Carleton Community Care Access Centre Leg Ulcer Care Protocol Task Force (2000).
Ottawa-Carleton Community Care Access Centre (CCAC) venous leg ulcer care protocol:
Development, methods and clinical recommendations. Ottawa, Ontario: Ottawa-Carleton
CCAC Leg Ulcer Protocol Task Force.