Department
of Podiatry - Vascular Assessment
Ischaemic
Ulceration
Like
all superficial ulcers, ischaemic ulcers are a breakdown in epidermal
and subdermal tissues. Ischaemic means ‘to hold back blood’,
and so ischaemic ulcers develop because there is inadequate blood supply
to an area. This simple aetiology explains much about why these ulcers
present the way they do.
The most common cause of the ischaemic state is atherosclerosis, and an
ischaemic ulcer is a good indicator of substantial peripheral arterial
disease (Nelson, 1992).
Common sites for ischaemic ulcers are the upper two thirds of the leg,
and on the periphery of the foot, especially the medial/lateral borders,
and on the digits. Ischaemic ulcers rarely present on the plantar weightbearing
surface (Nelson, 1992).
Ischaemic ulcers typically present as a deep, “punched out”
lesion that is dry with little or no exudate, and usually sharp borders.
There is minimal associated hyperkeratosis or oedema.
Unlike venous or neuropathic
ulcers, ischaemic ulcers result in moderate to severe pain, therefore
pain levels are a good indicator for diagnosis and monitoring progression.
Ask the patient what makes the pain worse/better, as an ischaemic ulcer
will be more painful on elevation or in bed, and relieved by standing/walking/hanging
their leg over the side of the bed.
Picture
of arterial ulceration around medial ankle.
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