Open Leg: Causes and Diagnosis

The ulcer itself is easy to recognize. For the treatment, however, the distinction according to the cause is indispensable. This often results already from the findings.

Differences between venous and arterial leg ulcers.

Venous leg ulcers are typically characterized by prolonged leg swelling and additional skin changes such as brownish spots (congestion spots due to the migration of red blood cells and deposition of their degradation products) or lack of pigmentation (atrophie blanche), skin shrinkage and hardening (induration), and a ring of veins at the edges of the feet (corona phlebectatica). The ulcer is usually located on the ankles, especially on the inner sides. It is not uncommon for it to ooze and for bacteria to colonize. This produces a foul odor.

Arterial leg ulcers initially tend to appear on the toes, heels and balls of the feet. The feet and legs are cool and pale, and the ulcers often hurt.

In addition, the medical history usually allows us to infer the cause – longstanding venous conditions or varicose veins or thromboses are often known; in the case of arterial ulcers, diabetes or high blood pressure is often present, and those affected smoke or have elevated blood lipid levels.

Further examinations

The focus of the apparative diagnostics is a special ultrasound examination (Doppler sonography) of the vessels, with which both the veins and the arteries can be assessed. In the case of suspected thrombosis, a contrast medium examination of the veins (phlebography) can be performed, and in the case of arterial occlusion, one of the arteries (angiography).

If there is a suspicion of skin changes of another cause, a tissue sample (biopsy) is taken; if an infection is present, the pathogens are determined in order to be able to initiate a suitable antibiotic therapy. A blood sample can be used to detect blood sugar, lipid metabolism and coagulation disorders. In addition, a whole range of special diagnostic procedures are also available