Arterial Ulcer
A slow-healing wound caused by poor arterial blood supply
Quick Facts
- Type: Chronic wound from poor circulation
- Common sites: Toes, feet, outer ankle, lower leg
- Underlying cause: Narrowed or blocked arteries
- Key feature: Painful, slow to heal
Overview
An arterial ulcer is an open wound that develops when the arteries cannot deliver enough oxygen-rich blood to the skin and tissues, usually of the lower leg, foot, or toes. Without adequate blood flow, even a small injury fails to heal and gradually breaks down into a painful sore. Arterial ulcers are also called ischemic ulcers, because ischemia means a lack of blood supply to a part of the body.
These ulcers are most often a sign of peripheral artery disease, in which fatty deposits narrow the arteries that carry blood to the limbs. Arterial ulcers differ from venous ulcers, which are caused by poor return of blood through the veins. Recognizing the difference matters, because the treatments are very different. Arterial ulcers are serious because the poor circulation that causes them can also threaten the survival of the limb if it is not addressed.
Symptoms
Arterial ulcers have features that reflect the underlying lack of blood flow:
- Location: Often on the toes, the tips of the feet, the outer ankle, or pressure points and bony areas.
- Appearance: A deep, punched-out wound with well-defined edges and a pale, gray, or yellow base, often with little bleeding.
- Pain: Frequently very painful, especially at night or when the legs are raised, and sometimes relieved by hanging the leg down.
- Surrounding skin: Cool, shiny, hairless, and pale or bluish, with weak or absent pulses in the foot.
Many people also notice leg pain when walking that eases with rest, a symptom called claudication, which points to the same circulation problem.
Causes
Arterial ulcers result from reduced blood flow through the arteries supplying the limb. The most common cause is:
- Peripheral artery disease: A buildup of fatty plaque (atherosclerosis) that narrows or blocks the leg arteries.
Other contributors include diabetes, which damages both large and small blood vessels; blood clots that block an artery; and certain conditions that cause blood vessel inflammation. Once blood flow is reduced, the skin becomes fragile, and any minor trauma, pressure, or injury that would normally heal instead develops into an ulcer that cannot close on its own. Smoking strongly accelerates the underlying artery disease.
Risk Factors
- Peripheral artery disease and atherosclerosis
- Diabetes
- Smoking, which is one of the strongest risk factors
- High blood pressure and high cholesterol
- Older age
- A history of heart disease or stroke
- Obesity and a sedentary lifestyle
Diagnosis
Diagnosis focuses on confirming the ulcer is due to poor arterial flow and measuring how severe the circulation problem is:
- Examination: Checking the wound's appearance and location, skin temperature and color, and the pulses in the foot.
- Ankle-brachial index (ABI): A simple test comparing blood pressure at the ankle and the arm to estimate blood flow to the leg.
- Ultrasound and other imaging: Doppler ultrasound, and sometimes CT or MRI angiography, to locate and measure arterial narrowing or blockage.
- Blood tests: To check for diabetes, cholesterol, and other contributing conditions.
Treatment
The central goal is to restore blood flow, because the wound cannot heal without it:
- Improving circulation: Procedures such as angioplasty (opening the artery with a balloon and often a stent) or bypass surgery to reroute blood around a blockage.
- Wound care: Careful cleaning, appropriate dressings, and protection of the wound, often by a specialized team.
- Managing risk factors: Stopping smoking, controlling diabetes, blood pressure, and cholesterol, and medicines to improve blood flow and prevent clots.
- Treating infection: Antibiotics if the wound becomes infected.
Unlike venous ulcers, arterial ulcers are usually not treated with tight compression bandages, which can further reduce blood flow. In severe cases where blood flow cannot be restored, surgery to remove dead tissue or, rarely, amputation may be necessary to control infection and pain.
Prevention
- Stop smoking, which is the single most important step
- Keep diabetes, blood pressure, and cholesterol well controlled
- Stay physically active, as regular walking can improve circulation
- Inspect your feet daily for cuts, blisters, or color changes, especially if you have diabetes or known artery disease
- Wear well-fitting, protective footwear and avoid injury to the feet
- Seek care early for any wound that is slow to heal
When to See a Doctor
See a doctor promptly for any leg or foot wound that does not heal, or for leg pain that occurs with walking or at rest. Seek urgent care if you develop:
- A foot or toe that is suddenly cold, pale, blue, or numb, which can signal a blocked artery and is an emergency
- Spreading redness, warmth, swelling, foul-smelling discharge, or fever, suggesting infection
- Severe or worsening pain in the leg or foot
Prompt treatment improves the chance of healing and can help prevent the loss of a limb.
Frequently Asked Questions
What causes an arterial ulcer?
Arterial ulcers are caused by poor blood flow through narrowed or blocked arteries, most often from peripheral artery disease. Without enough oxygen-rich blood, the skin cannot heal, and minor injuries break down into painful sores.
How is an arterial ulcer different from a venous ulcer?
Arterial ulcers come from poor artery blood flow and are typically deep, painful, and found on the toes, feet, or outer ankle with pale surrounding skin. Venous ulcers come from poor vein drainage and are usually shallower, found near the inner ankle, and accompanied by swelling. The treatments differ, so the distinction matters.
Why are arterial ulcers so slow to heal?
Healing requires a good blood supply to deliver oxygen and nutrients to the wound. Because arterial ulcers are caused by reduced blood flow, the tissue cannot repair itself until circulation is improved, often with a procedure to open or bypass the blocked artery.
Are compression bandages used for arterial ulcers?
Generally no. Compression is a mainstay for venous ulcers but can dangerously reduce blood flow in arterial ulcers. Treatment instead focuses on restoring circulation, so it is important that the type of ulcer is correctly diagnosed first.
When is an arterial ulcer an emergency?
Seek urgent care if a foot or toe suddenly becomes cold, pale, blue, or numb, or if a wound shows spreading redness, foul discharge, or fever. These can signal a blocked artery or serious infection that threatens the limb.
References
- MedlinePlus, U.S. National Library of Medicine. Arterial (ischemic) ulcers.
- Mayo Clinic. Peripheral artery disease (PAD) — Symptoms and causes.
- National Heart, Lung, and Blood Institute (NHLBI). Peripheral Artery Disease.
- Society for Vascular Surgery. Arterial ulcers.