Arterial leg ulcer

188 Arterial leg ulcer



Instruction


Look at this patient’s leg.



Salient features



History




• Intermittent claudication


• History of underlying cardiovascular or cerebrovascular disease


• Pain in the distal foot when the patient is supine (’rest pain’ syndrome)


• Impotence


• Absence of bleeding from the ulcer


• History of precipitating trauma or underlying deformity


• History of diabetes, chronic renal failure.



Examination




• Tender, punched-out ulcers on leg (usually away from the ankle region) (Fig. 188.1)


• The ulcer is usually in the plantar surface over the heads of first and fifth metatarsals (uncommon on the dorsum of the foot because the pressure is less sustained and perfusion is better)


• Cold atrophic skin


• Loss of hair


• Thickened nails


• Peripheral pulses are not palpable or diminished (in diabetics and in chronic renal failure the arteries may be calcified, making the results of pulse examination less reliable)


• Pallor on elevation


• Redness of foot on lowering the leg (dependent rubor)


• Sluggish filling of toe capillaries.

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  4. Arteriovenous fistula

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Arterial leg ulcer

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