Center for Advanced Wound Care

Understanding Arterial and Venous Ulcers: Causes, Symptoms, Differences and Treatment

Have you ever wondered why some wounds on your legs, ankles, or feet take much longer to heal than others? It’s because of the underlying circulatory system that wound healing plays a big role.

Arterial and venous ulcers are two common types of chronic wounds that develop when there are disruptions in the blood flow within your arteries and veins.

Though they have some common symptoms, it is essential to understand the difference between them.
This article will explain arterial versus venous ulcers, exploring their causes, symptoms, and treatment options.

What are Arterial Ulcers?

Arterial ulcers, also comprehended as Ischemic ulcers or ischemic wounds, occur on the lower legs or feet due to inadequate blood supply to the area.


To put it simply, every part of your body needs enough oxygen and nutrients to stay healthy and function.


When the arteries responsible for delivering this oxygen-rich blood to the tissues become narrowed or lack a strong supply, that area starts to wither and get damaged. If this happens in your legs, the damage creates open sores, known as arterial leg ulcers or ischemic ulcers.


Other causes of arterial ulcers include age, high blood pressure, kidney failure, diabetes, smoking, high cholesterol, trauma atherosclerosis, thickening of the arteries, and vasculitis.


In particular, elderly people with underlying conditions such as diabetes, hypertension, and peripheral artery disease (PAD) are often affected by this condition.

Symptoms of Arterial Wounds

When the skin and its underlying tissue are deprived of oxygen, the tissue starts to die off and forms an open wound.


This wound has a punched-out look and is round in shape with clear margins. You can spot such wounds in the ankle, heels, toes, between the toes and legs, and where there is pressure from walking or footwear.


Though the wound doesn’t bleed, it may change color into black, grey, brown, or yellow.

Other symptoms include:

  • Deep wound
  • Leg pain at night
  • Tight, hairless skin
  • The limb feels cold when touched, with little to no pulse
  • The skin feels tight
  • The skin and nails appear shiny, dry, and thin

Diagnosis of arterial ulcers

The best arterial leg ulcer specialists in Oxnard say that they will go through the patient’s history, do a careful examination, and do the following tests to confirm the diagnosis of arterial ulcers:

A Buerger test: The patient is made to lie flat and raise the leg to 45 degrees above horizontal for 1 minute. If the patient’s foot turns pale when elevated and bright red when lowered below the bed, the test is positive.

Capillary refill time: how much time is taken for small blood vessels in the skin surface to fill with blood after they are compressed is noted in seconds.

The extended time indicates arterial insufficiency.

Transcutaneous oximetry refers to measuring the skin’s oxygen content around the wound. If the measurements point out 40 mmHg, it’s vascular insufficiency, and <20 mmHg indicates severe insufficiency.

Ankle Brachial Pressure Index (ABPI): This non-invasive test measures blood pressure at your ankle and compares it to your arm’s blood pressure. A low ABI may indicate reduced blood flow to the lower extremities.

Several risk factors that contribute to arterial ulcers include:

  • Diabetes mellitus
  • Obesity 
  • Smoking 
  • Limited joint mobility
  • Foot deformity
  • Poor footwear 

Things to follow while treating arterial ulcers

  1. Quit smoking during treatment, as smoking can harden or clog the arteries that carry oxygen, affecting the blood supply.
  2. Avoid crossing your legs while seated.
  3. Avoid sitting or standing for long periods.
  4. Avoid cold temperatures.
  5. Protect your legs and feet from injury and infection.
  6. Exercise frequently and only when it’s comfortable.
  7. Avoid wearing constrictive socks.
  8. Ensure that footwear is correctly fitted to avoid points of rubbing or pressure.


Treatment of Arterial Ulcers

When it comes to treating arterial ulcers, your body will naturally heal the wounds in most cases. But here’s the catch: These stubborn wounds often take their sweet time to heal due to circulation issues, which may take months or years. It’s like having a never-ending battle with discomfort. This is why it is best to get proper treatment.


An arterial ulcer is treated based on its severity.

To heal an arterial ulcer, you must

  1. Improve circulation
  2. Treat the underlying cause with antibiotics.
  3. Remove contact irritation and pressure from the affected leg.
  4. Dressing the wound to maintain it dry and clean

Upon treating the wound, the doctor will recommend wearing special shoes or orthopedic devices to bring down the pressure on the sore.


Doctors may use surgery, including angioplasty, to restore blood flow to organ tissues. If that isn’t possible, they may recommend amputating the affected limb.


Looking for treatment for Arterial leg ulcers in Camarillo? Visit the Center for Advanced Wound Care and get it treated by healthcare professionals.


Complications of untreated arterial ulcers

When left untreated, arterial ulcers can result in infection and tissue necrosis, and in the worst-case scenario, many require amputation of the affected limb.

What are Venous Ulcers?

Also known as a venous stasis ulcer, the venous ulcer is caused by vein and blood flow issues that occur on your legs near your ankle.


Simply put, the veins have one-way valves that maintain blood flowing toward your heart.


When these valves become feeble or the veins scarred, the blood tends to flow backward and get collected in your legs. This is called venous insufficiency.


Also, the valves inside the leg veins control the blood pressure and allow it to drop when you walk.


But the issue pops up when the blood pressure doesn’t reduce while you walk due to venous insufficiency. This increased blood pressure in your legs cuts off the nutrients and oxygen supply to these tissues. This condition is called Venous hypertension, which leads to ulcer formation on your ankles.


Other causes of venous ulcers are varicose veins, blood clots, poor circulation, diabetes, kidney failure, obesity, infections, or inflammatory diseases.


This ulcer affects approximately 1 percent of the US population. 

Symptoms of Venous Ulcers

Venous ulcers are deep red and have an irregular-shaped, shallow wound. Unlike artery ulcers, venous ulcers are painless unless they get infected.

Other symptoms of venous ulcers are:

  • Inflammation 
  • Swelling
  • Itchy skin
  • Pus or other fluid oozes from the sore.
  • Foul odor
  • Scabbing or flaking
  • Brown or black skin
  • Unevenly shaped borders
  • Leg pain

Several risk factors that cause Venous ulcers are

  • Age
  • Obesity
  • Blood clots
  • Lymphedema
  • Standing for long periods
  • Sitting for a long time with legs dangling or positioned below heart level
  • Family history of venous ulcers
  • Sedentary lifestyle
  • Trauma, such as a fracture or burn

Diagnosis of Venous Ulcers

Doctors can diagnose venous ulcers by physically examining your leg when standing up and lying down.


They may ask about your health history to learn about different conditions that may have caused the ulcer. They also check the pulse at your ankles to ensure the arteries in your leg are working properly.


To confirm the venous ulcer, some tests are done, including:


Ankle-brachial index test, which gives the blood pressure readings of your arms and legs


A Doppler test is done to detect blood flow and ensure that the blood flowing via the veins is normal.


CT scan is also done to identify damaged or non functioning valves.

Treatment for Venous Ulcer

When a venous leg ulcer is appropriately treated with the necessary precautions, it will heal within 6 months. Treatment should always be carried out by a healthcare expert trained in compression therapy for leg ulcers. The treatment involves:

Cleaning and dressing the ulcer

Firstly, the wound must be healed. The debris or dead tissue around the wound is removed, and the area is washed and left to dry. After that, a simple, non-sticky dressing is used to dress your ulcer. This dresser needs change 1–3 times a week.


A firm compression bandage will be applied over the affected leg to improve vein circulation in your legs and treat the swelling caused by a venous ulcer. Since the bandages are designed to squeeze your legs, they boost the blood flow toward your heart.


Applying the compression bandage is a skilled procedure. So it must be done only by trained healthcare staff.


The bandage is recommended to be changed 1 to 3 times a week when the dressing is changed. Though you will have initial pain when the bandage is applied, the pain will subside once the ulcer starts to heal.


Book an appointment with the Center for Advanced Wound Care for the treatment of venous ulcers.

Treating itchy skin

If you develop rashes with scaly and itchy skin due to varicose eczema, treat the skin with moisturizer and a mild ointment prescribed by the doctor.


Avoid scratching your legs if they sense itchy, as this damages the skin, worsening the ulcer effect.

Things to follow while treating venous leg ulcers

  1. Keep your affected leg elevated when sitting or lying down.
  2. Regularly go on a walk and avoid standing for an extended period of time.
  3. Exercise your legs by moving your feet up and down.
  4. Stop smoking and reduce alcohol consumption.
  5. Wear comfortable, well-fitting footwear.
  6. If you’re overweight, reduce your weight with a healthy diet and regular exercise.

Venous ulcer complications

Venous ulcers also heal slowly, and sometimes treating them poses a challenge. An open wound can lead to infection.

Arterial versus Venous Ulcers

It’s often challenging to distinguish between arterial and venous ulcers, as they can occur on the lower extremities and share similar characteristics.

But the key differences between both conditions include:


Location: Arterial ulcers occur on the outer side of the ankle, feet, heels, or toes. Venous leg ulcers appear below the knee or on the inner ankle.

Causes: The arteries that carry rich oxygen sources get damaged, resulting in poor blood circulation. Thus resulting in arterial ulcers.

Venous leg ulcers occur due to damage to the veins that carry blood to the heart. This is caused by conditions such as blood clotting disorders, varicose veins, deep vein thrombosis, heart failure, obesity, and pregnancy.

Appearance: While arterial ulcers have a punched-out look with discoloration, venous ulcers can vary in how they look, have an irregular shape, and are less deep and red in appearance.

Characteristics: The main difference is that arterial ulcers are painful and uncomfortable, while venous ulcers are painless unless infected.

Treatment: Though arterial ulcers heal naturally, it takes more time. So, surgery and other interventions are done to treat arterial ulcers. The primary treatment for venous ulcers is compression therapy.

Final Words

We hope you gained clarity on venous versus arterial ulcers. Remember, arterial and venous ulcers might sound scary, but recovery is possible with proper treatment.


If you have the symptoms of arterial Leg Ulcers or venous ulcers or suspect them, get them treated by a specialized team of experts at the Center for Advanced Wound Care.


Our best arterial and venous leg ulcer specialist will thoroughly examine and treat the underlying disease by reestablishing circulation. 


From treating the wound to changing the dressing and prescribing medicines, our team will take every measure to restore your health. To schedule an appointment, call us at 805-653-5312 or fill out this form.



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