Leg ulcers – causes and diagnosis

Medical history and physical examination

The ulcer itself is easy to spot. For treatment, however, it is essential to distinguish between the causes. This often results from the findings.

Differences between venous and arterial leg ulcers

Typical for venous leg ulcers are long-standing leg swelling and additional skin changes such as brownish spots (congestion spots caused by the migration of red blood cells and deposits of their breakdown products) or missing pigmentation (atrophy blanche), skin shrinkage and hardening (induration) as well as a ring of veins on the edges of the feet (corona phlebectatica). ). The ulcer is usually on the ankles, especially on the inside. It is not uncommon for it to become wet and bacteria to settle. This creates a foul odour.

Arterial leg ulcers are more likely to appear on the feet, toes, heels, and balls first. Feet and legs are relaxed and pale, and ulcers are often painful.

In addition, the cause can usually be deduced from the medical history – long-standing venous disorders, varicose veins, or thromboses are often known; arterial ulcers are often associated with diabetes or high blood pressure, and those affected smoke or have elevated blood lipid levels.

Further investigations

The diagnostic equipment focuses on a special ultrasound examination (Doppler sonography) of the vessels, with which both the veins and the arteries can be assessed. If thrombosis is suspected, a contrast medium examination of the veins (phlebography) can be carried out in the case of arterial occlusions in one of the arteries (angiography).

Suppose there is a suspicion of a skin change of another cause; a tissue sample (biopsy) is taken. In that case, if there is an infection, the pathogens are determined to be able to initiate suitable antibiotic therapy. Blood sugar, lipid metabolism and coagulation disorders can be detected with a blood sample . In addition, there is a whole range of special diagnostic procedures available.