Ischemic or Arterial Ulcers

Arterial ulcer on the ankleWhat is it?

An ischemic ulcer or arterial ulcer (wounds) can result from any interruption of arterial blood supply to an area of the skin. It usually develops on the feet, frequently on the heels, tips of toes, or between the toes in a patient with vascular disease, and ankles.  They can occur in the nail bed if the toenail cuts into the skin; if the patient has had recent aggressive toe nail trimming; or in the event of the removal of an ingrown toenail.  The surrounding area may be pale and cool, suggesting poor blood supply.


Clogged arteries (atherosclerosis) are the most common cause of ischemic ulcers.

-Clogged arteries prevent a healthy supply of blood from flowing to the legs. This means that the tissues in your legs don’t get enough nutrients and oxygen.
-The lack of nutrients causes cells to die, damaging the tissue.
-Damaged tissue that does not get enough blood flow also tends to heal more slowly.

Conditions where the skin becomes inflamed and fluid builds up in the legs can also cause these ulcers.

Often people with poor blood flow also have nerve damage or foot ulcers from diabetes. Nerve damage makes it harder to feel an area in the shoe that rubs and causes a sore. Once a sore forms, lack of blood flow makes it harder for the sore to heal.


These include:

-Dark red, yellow, gray, or black sores.
-Raised edges around the wound (looks punched out).
-No bleeding.
-Deep wound through which tendons may show.
-Skin on the leg appears shiny, tight, dry, and hairless.
-Dangling the leg off the side of a bed or chair causes the leg to turn red.
-When you raise the leg, it turns pale and cool to touch.
-Leg pain, often at night. Pain may go away when the leg is dangled down.
-Ulcer may or may not be painful.

Who is at risk?

Anyone with poor circulation is at risk. Other conditions that predispose persons to ischemic wounds include:

-Diseases that cause inflammation, such as lupus
-High blood pressure
-Kidney failure
-Lymphedema, which causes fluid to build up in the legs

Ulcers on the heelsWound care

To treat an ischemic ulcer, your doctor will try to restore blood flow to your legs. You may need to take medicine. In some cases, you may need surgery.


-Debridement of the ulcer
-Appropriate dressing of the wound
-Treatment of infection and inflammation
-Protection of the wound
-Surgery to improve the blood supply
-Management of wound pain
-Diabetes management and nutrition
-Advanced therapies to stimulate tissue growth


If you are at risk for ischemic ulcers, taking these steps may help prevent problems:

-Check your feet and legs every day. Check the tops and bottoms, ankles, heels, and between your toes. Look for changes in colour, and red or sore areas.
-Wear shoes that fit properly, and don’t rub or put pressure on your feet. Wear socks that fit. Socks that are too big can fold up in your shoes and cause a sore.
-Don’t cross your legs when sitting. This can cut off blood flow to your legs. Try not to sit or stand too long in one position.
-Protect your feet from the cold.
-Do not walk barefoot. Protect your feet from injury.
-Don’t wear compression stockings or wraps unless advised by your doctor. These may restrict blood flow.

Certain lifestyle changes can help as well. If you have a wound, taking these steps can improve blood flow and aid healing:

-Quit smoking. Smoking can lead to clogged arteries.Quit smoking
-If you have diabetes, keep your blood sugar levels under control. This will help you heal faster.
-Exercise as much as you can. Staying active can help with blood flow.
-Eat a healthy diet and get plenty of sleep at night. Staying healthy will help wounds heal.
-Lose weight if you are overweight.
-Manage your blood pressure and cholesterol levels.


Check your doctor or podiatrist if you have any signs and symptoms of infection, such as:

-Redness, increased warmth, or swelling around the wound
-Extra drainage
-Fever or chills
-Increased pain.

Ulcer with Gangrene on the 4th toeIschemic ulcers frequently precede the need for an amputation, and wet or dry gangrene may also be associated with them. It is rare for an ischemic ulcer to heal if nothing can be done to improve the arterial blood supply to the affected area, so faithfully follow whatever regime that has been prescribed.

Your feet mirror your general health . . . cherish them!

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