8.2 Arterial ulcers

Arterial ulcers are caused by arteriosclerosis in the leg and foot arteries and arterioles due to reduced oxygen and nutrients to the skin. These ulcers occur when there is inadequate circulation and they are difficult to heal. It is important to assess the ankle brachial index (ABI) to determine the circulation in the foot.

Patients with arterial ulcers often had a history of smoking, and a family history of claudication. They often have pain when lifting their feet. The wound is often located at the distal, often over bony prominences. Arterial ulcers are punched out in appearance, occasionally deep and irregular in shape.  The wound bed is often dry and covered in necrotic tissue.

The skin around the wound may be pale, atrophic and shiny. The feet may be cold and have weak or absent pulses. Patients often complain of pain, especially after activity or after having elevated the foot.

When caring for these ulcers, very plain inactive dressings should be used. Dressings which promote autolysis such as gels should not be used especially where necrosis or gangrene is present. It is important to observe the degree of contamination and the development of infection of the wound. Infection in these wounds can develop quickly and may result in the need for systemic antibiotics. In infected wounds a referral to the tissue viability team is recommended. Patient education is also important in order to help patients change their lifestyle.