Arterial Ulcers

Poor perfusion can cause arterial ulcers or ischemic ulcers. Lack of oxygenation to the skin and tissues leads to the tissue death ending with an ulcer. Arteries are responsible for oxygenation and delivery of nutrients to different tissues. Narrowing of the arteries or damage to the small blood vessels in the extremities cause reduction in blood flow and leads to ulceration.


-Arterial ulcers are round in shape.

-Borders are well defined

-Location of arterial ulcers is between the toes, on tip of the toes, outer of ankle, and pressure points in feet.

– Arterial ulcers usually are deep often extending to underlying tissues and tendons.

– In arterial ulcers, there is no sign of tissue growth

-Color of arterial ulcer is yellow, grey, or black

– Usually no bleeding from an arterial ulcer

– Limbs are cold in touch

– Decreased pulses in the extremities

-Atrophic nail and skin

– Decreased hair distribution

– Shiny, thin, and dry skin on affected limbs

– Delayed capillary refill

-The base color of the extremity may turn red when dangled and pale when elevated

-Arterial ulcers often are painful specially when exercising, at rest or during the night

– Dangling the affected limbs can decrease the pain

Etiology and risk factors

Peripheral Vascular Disease (PVD)

Chronic vascular insufficiency

Vasculitis (inflammatory damage of blood vessels)

Diabetes mellitus (DM)

Renal failure





Limited joint mobility

Increased age

Risk Factors

Foot deformity and callus formation resulting in focal areas of high pressure

Poor footwear that inadequately protects against high pressure and shear


Peripheral neuropathy

Diagnostic Studies

Transcutaneous oxygen measurement

Ankle brachial index (ABI)

Absolute toe systolic pressure


Buerger’s test

Arterial Doppler studies


Increasing circulation is the main goal of treatment. Surgery can restore blood flow to the ischemic area.

Modifying contributing factors can slow or stop the progression of the local ischemia. Additionally, there are boots and pumps available to augment perfusion to the affected limb. Oxygen Hyperbaric also is another option to increase oxygenation to the area.

Local wound care can enhance wound healing along with resolving underlying causes. It can prevent infection and related complication.