What makes an arterial ulcer different
Arterial ulcers form when narrowed or blocked arteries restrict blood flow to the lower leg and foot below what the tissue needs to survive. The problem is supply, not drainage. Unlike venous ulcers around the inner ankle, arterial ulcers tend to appear on the toes, the outer ankle, the heel, or wherever the foot takes pressure and is furthest from the heart. The surrounding skin is often pale, shiny, cool, and hairless, all signs of chronic undersupply.
Why pain is a key signal
Arterial wounds are usually painful, and the pain often worsens with elevation, because raising the leg works against gravity when blood flow is already inadequate. Pain in the foot when lying flat that improves by dangling the leg off the bed is a specific sign of significant arterial disease and warrants urgent vascular evaluation.
Why compression is not the answer here
Compression, the primary treatment for venous ulcers, can reduce circulation further in a leg with arterial disease and accelerate tissue loss. Any degree of arterial involvement changes the equation. Palm assesses for arterial disease, including checking ankle pulses, before applying any compression and coordinates vascular evaluation when perfusion is the limiting factor.
Signs requiring urgent evaluation
- Rest pain, especially pain that improves by dangling the leg
- A foot or lower leg that is pale, blue-tinged, or cold versus the other side
- Sudden worsening pain in a previously stable wound
- Black or gangrenous tissue that is spreading
- No palpable pulse at the ankle or top of the foot
Arterial wounds often need vascular intervention before they can heal. Wound care alone will not close a wound the circulation cannot support.