Common Ulcers of the Ankles and Feet



Chronic Venous Insuffciency 

This condition usually appears over the medial and sometimes the lateral malleolus. The ulcer contains small, painful granulation tissue and fibrin; necrosis or exposed tendons are rare. Borders are irregular, flat, or slightly steep. Pain affects quality of life in 75% of patients. Associated findings include edema, reddish 

pigmentation and purpura, venous varicosities, the eczematous changes of stasis dermatitis (redness, scaling, and pruritus), and at times cyanosis of the foot when dependent. Gangrene is rare.



Arterial Insuffciency 

This condition occurs in the toes, feet, or possibly areas of trauma (e.g., the shins). Surrounding skin shows no callus or excess pigment, although it may be atrophic. Pain often is severe unless neuropathy masks it. Gangrene may be associated, along with decreased pulses, trophic changes, foot pallor on elevation, and 

 dusky rubor on dependency. 



Neuropathic Ulcer 

This condition develops in pressure points of areas with diminished sensation; seen in diabetic neuropathy, neurologic disorders, and Hansen disease. Surrounding skin is calloused. There is no pain, so the ulcer may go unnoticed. In uncomplicated cases, there is no gangrene. Associated signs include decreased sensation and absent ankle jerks. 



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