This website uses cookies. By continuing to use this website you are giving consent to cookies being used. For information on cookies and how you can disable them visit our Privacy and Cookie Policy.
Got it, thanks!Medically Reviewed by Dan Brennan, MD on June 18, 2021
Arterial wounds, also known as arterial ulcers, are painful injuries in your skin caused by poor circulation. Arterial ulcers typically happen when blood is unable to flow into the lower extremities, like the legs and feet. When the skin and underlying tissue are deprived of oxygen, the tissue starts to die off and form an open wound. Arterial wounds tend to be extremely painful and uncomfortable. Due to poor circulation, arterial wounds may heal slowly. The lack of circulation can also make it difficult for the red blood cells to deliver the nutrients needed to heal. Without oxygen-rich blood, white blood cells may not be able to fight off bacteria, making the wound more likely to become infected. If left untreated, arterial ulcers can lead to more serious diseases or complications, including infection, tissue necrosis, and, in extreme cases, amputation. Arterial wounds typically have a “punched-out” look. They may be round in shape with well-defined margins — meaning the sore may be deeper in the skin than the surrounding area of healthy skin. Arterial ulcers also tend to have a distinct color. The wound itself typically doesn’t bleed and may be black, grey, brown, or yellow. The limb may turn red when dangled downward, and become pale when propped up or elevated. In addition, you might have:
They’re often found on the outer ankle, on the heels, on the toes, or in between the toes. They can also happen in areas where there’s pressure from walking, exercising, or wearing footwear.
Arterial wounds are most often caused by blocked arteries. This may prevent nutrient-rich blood from flowing to the extremities, creating an open wound.
Other potential causes include:
Other disorders may also lead to arterial wounds, including high cholesterol, heart disease, high blood pressure, or sickle cell anemia.
Several risk factors may also contribute to arterial ulcers, including:
Arterial ulcers and venous ulcers are both open sores found on the lower extremities, like the legs and feet.
Arterial ulcers are often the result of damage to the arteries due to poor circulation and blood flow. Venous ulcers develop from damage to the veins due to insufficient blood flow to the heart.
Because they both form on the lower leg, it can be difficult to differentiate them. While they’re very similar, there are some differences you can use to identify each.
Arterial Ulcers. Arterial ulcers have a distinct “punched out” appearance and are typically circular with a red, yellow, or black coloration. They are usually extremely painful.
Venous Ulcers. Venous ulcers tend to vary in appearance. They are usually deep red and may have an irregular shape. The wound itself may be more shallow.
Venous ulcers are often painless unless they are infected. Other distinguishing characteristics might include:
- Inflammation
- Swelling
- Itchy skin
- Scabbing or flaking
- Brown or black skin
- Discharge
While your body can heal arterial wounds on its own, the natural healing process will be significantly slower due to circulation issues. Many people with arterial ulcers experience chronic pain and sores that take months or years to fully heal.
Treatment for arterial ulcers will depend on the severity of the arterial disease. Your physician may conduct diagnostic tests to assess possible forms of treatment, as well as the potential for wound healing.
Goals for healing include: During recovery, you may be asked to wear special shoes or orthopedic devices to relieve pressure on the sore. Doctors may use surgery, including angioplasty, to restore blood flow to tissues in organs. In rare cases where blood flow can’t be restored, they may recommend amputation of the affected limb. Your doctor will give you instructions to care for your wounds at home. These may include:
- Keeping the wound clean and dry by changing the dressing
- Taking all prescribed medications
- Drinking plenty of water
- Following a healthy diet
- Exercising regularly, as directed by your doctor
- Wearing orthopedic shoes
- Wearing compression wraps if needed
To prevent ulcers from developing again — or the current ulcers from getting worse — there are some ways you can lower your risk factor. These include managing your blood pressure and cholesterol, quitting smoking, exercising regularly (if appropriate), and watching your intake of sodium.
© 2020 WebMD, LLC. All rights reserved. View privacy policy and trust info1. Mani R, Romanelli M, Shukla V. London: Springer London; 2013. Measurements in Wound Healing: Science and Practice. [Google Scholar]
2. Agale S V. Chronic leg ulcers: epidemiology, aetiopathogenesis, and management. Ulcers. 2013;2013:1–9. [Google Scholar]
3. Rayner R, Carville K, Keaton J, Prentice J, Santamaria N. Leg ulcers: atypical presentations and associated co-morbidities. Wound Pract Res. 2009;17(04):168–185. [Google Scholar]
4. Järbrink K, Ni G, Sönnergren H et al. The humanistic and economic burden of chronic wounds: a protocol for a systematic review. Syst Rev. 2017;6(01):15. [PMC free article] [PubMed] [Google Scholar]
5. Yost M L.The Cost of Amputation in 2014. Lecture at 4th Annual Amputation Prevention Symposium. August 14-16, 2014
6. Peacock J M, Keo H H, Duval S et al. The incidence and health economic burden of ischemic amputation in Minnesota, 2005-2008. Prev Chronic Dis. 2011;8(06):A141. [PMC free article] [PubMed] [Google Scholar]
7. MacKenzie E J, Jones A S, Bosse M J et al. Health-care costs associated with amputation or reconstruction of a limb-threatening injury. J Bone Joint Surg Am. 2007;89(08):1685–1692. [PubMed] [Google Scholar]
8. Bell D. Current concepts in vascular assessment of wounds. Pod Today. 2018;31(08):26–32. [Google Scholar]
9. Pierpont Y N, Dinh T P, Salas R E et al. Obesity and surgical wound healing: a current review. ISRN Obes. 2014;2014:638936. [PMC free article] [PubMed] [Google Scholar]
10. Suckow B.Amputation rate and cost of amputation in the United StatesCurrent Data. Lecture at the Amputation Prevention Symposium 2018. August 8, 2018
11. Feinglass J, Pearce W H, Martin G J et al. Postoperative and late survival outcomes after major amputation: findings from the Department of Veterans Affairs National Surgical Quality Improvement Program. Surgery. 2001;130(01):21–29. [PubMed] [Google Scholar]
12. United States Cancer Statistics.Data Visualizations. Survival: 5-year Relative Survival, All Types of Cancer, Invasive Cancers Only, United StatesAvailable at://gis.cdc.gov/Cancer/USCS/DataViz.html. Accessed August 22, 2018
13. Bryant R, Nix D. St. Louis, MO: Elsevier; 2016. Acute and Chronic Wounds: Current Management Concepts. 5th ed. [Google Scholar]
14. Bunte M C, Shishehbor M H. Angiosome-guided intervention in critical limb ischemia. Interv Cardiol Clin. 2017;6(02):271–277. [PubMed] [Google Scholar]
15. McCallum J C, Lane J S., III Angiosome-directed revascularization for critical limb ischemia. Semin Vasc Surg. 2014;27(01):32–37. [PubMed] [Google Scholar]
16. Špillerová K, Settembre N, Biancari F, Albäck A, Venermo M. Angiosome targeted PTA is more important in endovascular revascularisation than in surgical revascularisation: analysis of 545 patients with ischaemic tissue lesions. Eur J Vasc Endovasc Surg. 2017;53(04):567–575. [PubMed] [Google Scholar]
17. Uzun G, Mutluoglu M. Images in clinical medicine. Dependent rubor. N Engl J Med. 2011;364(26):e56. [PubMed] [Google Scholar]
18. Bergan J J, Schmid-Schönbein G W, Smith P D, Nicolaides A N, Boisseau M R, Eklof B. Chronic venous disease. N Engl J Med. 2006;355(05):488–498. [PubMed] [Google Scholar]
19. Leone S, Pascale R, Vitale M, Esposito S. [Epidemiology of diabetic foot] Infez Med. 2012;20 01:8–13. [PubMed] [Google Scholar]
20. Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes. 2015;6(01):37–53. [PMC free article] [PubMed] [Google Scholar]
21. Taylor G I, Palmer J H. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40(02):113–141. [PubMed] [Google Scholar]
Page 2
Summary of wound characteristics
Skin changes | Shiny, thin, flaky, hair loss, rubor (pinkish red) | Hyperpigmented (hemosiderosis—purple, dark reddish brown), telangiectasias, thickening (lipodermatosclerosis), peri-wound maceration, scaling/crusting | Callus |
Location | Foot more often than leg | Lower leg, almost never foot | Almost always plantar foot, sometimes side or dorsum of foot |
Laterality of leg | Usually lateral | Usually medial | N/A |
Distribution | Angiosomal | Gaiter | Pressure points |
Wound edges | Well defined | Irregular, poorly defined | Frequent callous, well defined (“punched-out” appearance) |
Wound bed | Pale or necrotic | Dark red, fibrinous slough | Typically red |
Eschar | Common | Never | Sometimes |
Exudate | Rare | Always | Almost always |
Odor | If infected (gangrene) | Usually none | Strong if infected |
Pain (in ulcer) | Uncommon unless infected or acute ischemia | Uncommon unless infected | Never |
Preceding trauma | Common | Uncommon | Common |
Edema | No | Yes | Usually no unless mixed, Charcot, or infection |
Sensation | Normal | Normal | Absent or severely diminished, paresthesia |
Temperature | Cold | Normal | Usually normal unless mixed arterial |
Pulses | Abnormal | Normal | Abnormal only if arterial component |
Delayed capillary refill | Sometimes | Only if arterial component | Only if arterial component |
Elevational pallor | Present | Absent | Absent (unless arterial component) |
Dependent rubor | Present | Absent | Absent (unless arterial component) |
Pain with leg raise | Increased | Decreased | No change |