Differential diagnosis: Assessment of the lower-extremity ulcer - Is it arterial, venous, neuropathic?
A non-healing ulcer of the lower extremity may be multifactorial in origin. The classic description includes: an ulcer superior to the medial malleolus usually indicating venous disease; ulceration of the anterior tibial surface as reflective of blood dyscrasias; ulcers at areas of pressure that may or may not be related to neuropathy, especially with diabetes mellitus; and ulceration of the toe and heel that are arterial. These descriptors are best used as starting points for identifying the cause of these lesions. The most important information is acquired through a thorough patient history and physical examination. Non-invasive testing is a valuable and necessary adjunct; invasive testing is often required before definitive or palliative therapy, especially in ulcers of arterial origin.
Goldstein, DR; Vogel, KM; Mureebe, L; Kerstein, MD
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