The following symptoms and complaints may indicate venous leg ulcer:
Leading symptoms
Predilection sites (body regions where the disease occurs preferentially): onset above or behind the medial malleolus (inner ankle).
Therapy-resistant ulcerations occur frequently.
Comparison of ulcer types
Venous ulcer | Arterial ulcer | Diabetic/neuropathic ulcer | |
Ulcer | Flat ulcer, often occupied, that is polycyclic limited “gaiter ulcer” (in insufficiency of the saphenous vein parva (VSP) and other veins): Ulcer occupies the entire circumference (circumference) of the lower leg. | Necrotic ulcer, as if punched out. | Circular, as if punched out, partly urgent in depth, partly also superinfected |
Localization | Above or behind medial malleolus (inner malleolus)(medial malleolar (inner) > lateral malleolus (lateral)) | Arterial end-stream areas: Toe tips and interspaces | Pressure points; altered foot architecture (due to progressive descent of the metatarsalia (MT; metatarsal bones) in the forefoot), e.g., MT II and III distal |
Ulcer environment | Stasis purpura/stasis hemorrhage; lipodermatosclerosis nun (stasis fibrosis of the skin)varicosis (presence of varices (varicose veins)), peripheral edema (swelling), stasis dermatitis (stasis eczema) | Shiny skin, also hair loss (tibial baldness/leg baldness). | Partially pronounced surrounding callus formation (unless there is concomitant ischemia/reduced blood flow) |
Pain | Mild to moderate pain; elevation of leg improves pain | Severe pain, especially with prolonged walking or elevation of the legNote: drooping the leg improves pain. | Painless. |
More hints | S. a. peripheral arterial occlusive disease (pAVD) | S. a. diabetic foot/diabetic polyneuropathy |
Warning signs (red flags)
- Malnutrition (especially protein deficiency)
- Pain in the muscles → think of: peripheral arterial occlusive disease (pAVK).
- Deep ulcers → think of: arterial component.
- No healing after three months → refer to an angiologist (vascular disease physician).