Result from insufficient blood supply to the skin due to the peripheral arterial disease = ischaemia - necrosis and poor wound healing

• associated with PAD
• Occur distally affecting toes or dorsum of foot

Features:

• Smaller and deeper than venous ulcers
• ulcers have a well defined borders and a punched out appearance
• Pale colour due to poor blood supply
• less likely to bleed
• are painful
• pain worse when lying horizontally (worse at night)
• pain is worse on elevating and improved by lowering the leg (gravity helps the circulation)

Investigations

• ABPI - Assess extent of PAD
• Duplex USS, CT, angio - reduced arterial flow

Management

• Same as for PAD
• reducing modifiable risk factors- treat hypertension, prescribe statin, prescribe antiplatelet.