Venous and arterial leg ulcers: what is the difference?
Leg ulcers are not all the same. Venous and arterial ulcers have different causes and treatments, and a treatment that helps one can be dangerous for the other. Correct treatment starts with identifying the type.
This information is general education and does not replace an individual medical assessment. Do not change your treatment or dressings without speaking to your care team.
What causes each type?
Venous ulcers are caused by poor return of blood from the legs to the heart. Blood pools, pressure in the veins rises, and the skin is affected over time. They are the most common type of leg ulcer.
Arterial ulcers are caused by narrowed or blocked arteries that reduce the supply of oxygen-rich blood to the leg and foot.
Both causes can occur in the same person; this is called a mixed ulcer.
A quick comparison
| Feature | Venous ulcer | Arterial ulcer |
|---|---|---|
| Usual location | Lower leg above the ankle, often on the inner side | Toes, foot, heel and over bony points |
| Appearance | Often shallow with irregular edges | Well-defined, can look “punched out” and deep, with a pale base |
| Exudate | Often moderate to heavy | Usually low |
| Surrounding skin | Swelling, brown staining, eczema and hardened skin | Shiny, thin, hairless skin; cool foot with weak pulses |
| Pain | Aching or heaviness, usually better with the leg raised | Can be severe; worse with the leg raised or at night, eased by hanging the leg down |
| Treatment principle | Compression therapy once the arteries are confirmed healthy, leg elevation and activity | Restoring blood supply through a vascular surgeon |
Why the arteries must be checked before compression
Compression (bandages or stockings) is the foundation of venous ulcer treatment, but in people with poor arterial supply it can reduce blood flow further and cause serious harm.
This is why guidelines require a circulation assessment before compression starts, such as checking pulses and measuring the ankle-brachial pressure index (ABPI), or other tests the team chooses. Never apply compression before this assessment.
Signs that need urgent review
- A cold, pale or discoloured foot.
- Foot pain at rest, especially at night.
- Toes turning black.
- Signs of spreading infection around the ulcer.
How correct care begins
- A full assessment of the ulcer and the person, including circulation.
- Identifying the ulcer type, with referral to a vascular surgeon when needed.
- A wound-care plan that also treats the cause: compression for venous ulcers once the arteries are confirmed healthy, or improving blood supply for arterial ulcers.
- Regular follow-up and measurement of progress.
Read also: Chronic wound care.
Educational videos
Watch the educational videosShort wound-care explainers on InstagramA multidisciplinary team
A complex wound is never treated by one specialty alone. Care is coordinated with a multidisciplinary team according to each case, because healing depends on treating the cause: circulation, infection, pressure, nutrition and the need for surgery.
- Orthopaedic surgery
- Vascular surgery
- General surgery
- Plastic and reconstructive surgery
- Podiatry
- Infectious diseases
- Clinical nutrition
- Other healthcare professionals as each case requires
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References
- De Maeseneer MG, Kakkos SK, Aherne T, et al. European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. European Journal of Vascular and Endovascular Surgery. 2022;63(2):184–267.
- Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Journal of Vascular Surgery. 2019;69(6S):3S–125S.
- Atkin L, Bućko Z, Conde Montero E, et al. Implementing TIMERS: the race against hard-to-heal wounds. Journal of Wound Care. 2019;28(Sup3a):S1–S50.
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