Arterial leg ulcers

Overview – what is an arterial leg ulcer?

Arterial ulceration can occur on the foot or lower leg and is the result of an underlying problem with the supply of blood to the leg. It is part of a condition also known as peripheral arterial disease (PAD).

Symptoms – what are the key symptoms of arterial leg ulcers?

Symptoms can include:

• Numbness or weakness in your leg
• The skin on your leg can look red when hanging down and go paler when lifted up
• A non-healing wound which is very painful
• Pain which can be usually worse at night and many people complain that they cannot sleep in bed. This results in them sleeping in a chair or feeling the only way to get relief if they hang their foot out of the bed

What causes arterial leg ulcers?

Arterial ulceration stems from a condition known as peripheral arterial disease (PAD).

It is caused by a build up of fatty deposits inside the arteries of the leg. Over time these deposits make the arteries narrower and result in a restriction of the blood flow to the leg. This is also called atherosclerosis.

Risk factors include

• Smoking
• High blood pressure
• Diabetes
• High cholesterol

Diagnosis – getting diagnosed with an arterial leg ulcer

Your GP or Practice Nurse will carry out an assessment of your legs. They will look for evidence of wounds, shiny skin, lack of hair and brittle toenails. They will also feel for the pulses in your groin, behind your knee and your feet. After this they should complete a test called an ABPI which takes the blood pressure of both arms and both feet and compares the results. If you have arterial disease the blood pressure in your legs will be lower.

In some cases, people with Peripheral Arterial Disease (PAD) can develop critical limb threatening ischaemia which is when the blood supply has become severely restricted. This is a serious complication and requires urgent medical attention. In some cases, an amputation of the lower limb is required

You should be aware of:

• Severe pain in your foot and leg which does not go away even when resting
• Your foot changing colour and becoming cold and numb
• Your wound turning black (necrosis) and beginning to smell. Be aware that skin changes may be harder to see on black or brown skin

Treatment – how to treat arterial leg ulcers

If your healthcare professional has informed you that they suspect the ulceration is arterial in nature they should refer you to the Vascular Department for specialist input.

For some people, the treatment will include procedures to improve the blood supply.

It is usual practice that the Vascular Consultant or Nurse will see you and will arrange for you to have a scan to look at the arteries in more detail. This will give further information to make a decision whether you might want to consider surgery. Sometimes a narrowing or blockage in your artery can be opened up and stretched using a small balloon (angioplasty). This procedure is done under a local anaesthetic in the radiology department of hospital.

If your symptoms are very severe and the blockage is too big to open up with a balloon, a bypass operation might be an option. This is where a vein from your leg or an artificial artery is used to carry the blood past the blockage. Your vascular specialist will talk through the options with you.

Once the supply has been restored, most people will see an improvement in the ulceration and their pain will also reduce.

Prevention – how to prevent arterial leg ulcers occurring or reoccuring

If you are a smoker, the single most important change that can be made is to stop smoking. If you continue to smoke your symptoms will undoubtedly progress.

Exercise is proven to be a significant factor in reducing the severity in symptoms of PAD. It is also good for improving your mood and self-esteem. Living with arterial disease or ulceration can be upsetting and affect your quality of life.

How to reduce the risks of vascular disease (web page)

Outlook – healing arterial leg ulcers

Arterial disease is not curable but can be treated and maintained with lifestyle changes and the addition of medications.

Your GP should start you on a high dose statin and an anti-platelet such as Aspirin or Clopidogrel. Arterial ulceration will often improve once the blood supply has been restored.

Harm – the risk factors

Inaction or insufficient action on arterial leg / foot ulcers can cause harm. This includes:

• Not checking legs properly or doing basic checks, such as a Doppler test
• Not performing a vascular assessment
• Not being referred to vascular services if required

If you have any concerns about the treatment or care you are receiving, it is important to speak up.

Learn more about harm

Resources – for arterial ulcers

Angioplasty and stent configure (web page)

Problems with leg circulation  (web page)

How to reduce the risks of vascular disease (web page)