This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Differential diagnosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Is the ulcer of purely vascular origin, arterial or venous, is there an element of neuropathy, or is ulceration occurring as part of a generalized disease process?

  • Arterial ulcer:
    • typically on the dorsum of the foot with a punched-out appearance, with ischaemia and necrosis. This is typical in a person with atherosclerosis; pale or blue, mottled, shiny, cold skin; prolonged capillary refill; nail dystrophy; reduced hair growth; and calf muscle wasting of the limb
  • Combined arterial and venous insufficiency:
    • seen in 10-20% of leg ulcers (1)

Systemic diseases in which there are often leg ulcers include:

  • diabetes mellitus: ulcer is typically on the foot over a bony prominence. This may have neuropathic, arterial, or venous components (1)
  • rheumatoid arthritis (vasculitic) - the ulcer is typically deep, well demarcated and punched out on the dorsum of foot or calf. Persons with rheumatoid arthritis might also have venous disease due to reduced mobility, neuropathy, and possibly impaired healing due to systemic corticosteroids
  • syphilis: ulcer with undermining edge (1)
  • chronic ischaemia due to atherosclerosis
  • spinal cord lesions
  • systemic vasculitis associated with polyarteritis nodosa, SLE, scleroderma or Wegener's granulomatosis:
    • multiple leg ulcers that are deep and necrotic. There is usually an atypical distribution with vasculitic lesions like nail-fold infarcts and splinter haemorrhages elsewhere (1)
  • malignancy - especially if the ulcer is long standing and slightly atypical
  • sickle cell disease and other haemoglobinopathies; in patients of Mediterranean origin
  • Other possible causes for leg ulcers include traumatic ulcer, sarcoidosis, tropical ulcer, or pyoderma gangrenosum

Reference:

1. Pannier F. Differential diagnosis of leg ulcers. Phlebology 2013 Mar:28 Suppl 1:55-60.

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.