In today’s times leg wounds are commonly due to the following causes :
Venous Ulcers : Causes :
- Varicose Veins
- Deep Venous Thrombosis
- Signs of change due to venous disease : leg pain/swelling especially during evenings , sclerosis of the skin(LDS) , hyperpigmentation , ankle flare of veins
- Previous ulcer history or family history of varicose veins(50%)
- Previous fracture or other leg trauma
Arterial ulcers (Gangrene) : Causes :
- Ischaemic Heart disease
- Peripheral Arterial disease
Any two or more causes in combination
Venous ulcers are commonly below mid calf to around the malleoli. They are shallow and can be painful with a burning sensation and will commonly have fluid coming out of them.
Arterial ulcers may occur in any area, however commonly at tips of toes and dorsum of foot. They are extremely painful and are comparatively dry as compared to venous ulcers. Pain is severe at night and while lying down and some relief can be got by dangling the legs…which is what most patients do. They are unlikely to be able to sleep at night.
These are pictures of dry gangrene of the toes and ischaemic ulcer on the plantar surface of the foot due to reduced arterial flows
Mixed ulcers may have a combination of these symptoms.
This is a mixed ulcer in a diabetic with arterial blocks, bone infection(Osteomyelitis) & venous insufficiency.
This is a patient with a long standing ulcer of mixed etiology, venous insufficiency with a vasculitic component.
Neurotrophic or Pressure ulcers occur in the pressure bearing areas, especially tips of toes, ball of foot , heel, sacral area in bedridden patients. They will not heal till the pressure is relieved.
Heel ulcer in a diabetic which developed due to prolonged pressure on the heel while lying in a supine position. Such ulcers are fairly common with bed ridden patients & long ICU/hospital stays. Though difficult to treat they are not incurable.
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