How to Tell the Difference Between Types of Leg Wounds

Medically reviewed by Mohamed T. Hassan, MD, DABVLM, RPVI, on November 8, 2024

Leg ulcers are a frustrating and often painful condition that can seriously impact your quality of life. These open sores or wounds on the legs can take a long time to heal and may even become chronic if not treated properly. But not all leg wounds are the same. Understanding the different types can help you seek the most effective treatment and avoid complications.

In this blog, Mohamed T. Hassan, MD, DABVLM, RPVI, an expert in vein care, provides a comprehensive overview of the three most common types of leg ulcers—venous, arterial, and diabetic—so you can better understand your condition and make informed decisions about your care. Dr. Hassan is the lead physician at Center for Vein Restoration vein clinic locations in Hoover (Birmingham), Alabama, and Trussville, Alabama.

Dr. Hassan is board-certified in Internal Medicine. He completed a Venous and Lymphatic Medicine fellowship with the Center for Vein Restoration, where he received in-depth training in the diagnosis, prevention, and treatment of venous disease, noninvasive duplex scanning of the venous and arterial systems, and a variety of minimally invasive methods for treating venous insufficiency.

Dr. Hassan writes:

Venous Leg Ulcers (VLUs)

Venous leg ulcers are the most common type of chronic wound, accounting for 70-80 percent of all lower leg ulcers. They are a late-stage manifestation of chronic venous insufficiency (CVI), a condition in which the veins in the legs are unable to send blood back to the heart efficiently. This inefficiency causes blood to pool in the lower legs, leading to increased pressure in the veins. Over time, this pressure damages the skin and underlying tissue, eventually leading to the development of an ulcer.

Key Characteristics of Venous Leg Ulcers:

• Location: These ulcers usually form just above the inner ankle, although they can appear elsewhere on the lower leg.
• Appearance: They are typically shallow wounds with irregular, ragged edges.
• Pain: VLUs are often painless in the early stages but can become quite painful as they progress.
• Additional Symptoms: The skin around the ulcer may become discolored (brownish), itchy, or scaly. Swelling, varicose veins, and a feeling of heaviness or aching in the legs are common. Due to the swelling, the skin may also look tight or shiny.
• Pain Relief: Elevating the leg or wearing compression stockings often helps relieve symptoms, as these measures improve blood flow back toward the heart.

People with venous ulcers often find their condition worsens after standing for long periods but improves when they elevate their legs or wear compression stockings. If you notice swelling and discoloration around the ulcer, it's essential to consult a healthcare provider for proper management, as untreated venous ulcers can lead to infection and other complications.

See an image of a venous leg wound (before and after vein treament) at the bottom of this blog.

Arterial Ulcers: Caused by Poor Blood Flow

Arterial ulcers, also known as ischemic ulcers, are caused by poor blood circulation in the lower extremities, typically due to peripheral arterial disease (PAD). In PAD, narrowed or blocked arteries restrict the flow of oxygen-rich blood to the legs, causing tissue death and the formation of ulcers. Unlike venous ulcers, which result from blood pooling, arterial ulcers happen when blood can't adequately reach the affected area, leading to oxygen deprivation and tissue breakdown.

Key Characteristics of Arterial Ulcers:

• Location: These ulcers typically occur below the ankle, often on pressure points like the toes, heels, or outer ankles.
• Appearance: Arterial ulcers tend to have a "punched-out" appearance, with smooth, well-defined edges. They are often deeper than venous ulcers.
• Pain: Arterial ulcers are extremely painful, and the pain worsens when the leg is elevated or during walking—the opposite of venous ulcers, where elevation tends to relieve discomfort.
• Additional Symptoms: The skin around the ulcer may appear cold, pale, or shiny, and there may be a noticeable lack of hair growth on the legs or feet. The skin may also feel cool to the touch, and the pulse in the affected leg may be weak or absent.

Due to poor blood flow, arterial ulcers are slow to heal and may not heal at all without medical intervention. If you experience severe leg pain that worsens with elevation or activity, along with skin changes, it's essential to seek medical attention to assess your arterial health.

See an image of an arterial ulcer (toe) at the bottom of this blog.

Diabetic Ulcers (Neuropathic Ulcers)

Diabetic ulcers, or neuropathic ulcers, commonly affect individuals with diabetes due to a combination of poor circulation and nerve damage (neuropathy). People with diabetes often lose sensation in their feet, making them less likely to notice minor cuts, blisters, or pressure sores. These small injuries can quickly become infected without proper care and develop into serious ulcers.

Key Characteristics of Diabetic Ulcers:

• Location: Diabetic ulcers are most often found on the soles of the feet, particularly on pressure points such as the ball of the foot or the heel.
• Appearance: These ulcers tend to be round and shallow, with the surrounding skin appearing dry, cracked, or calloused.
• Pain: Unlike venous and arterial ulcers, diabetic ulcers are often painless because of nerve damage. This lack of sensation can lead to further injury and delayed healing.
• Additional Symptoms: Diabetic ulcers are often associated with numbness or tingling in the feet. The skin around the ulcer may become red, swollen, and prone to infection. In more advanced cases, there may be pus or a foul odor emanating from the wound.

Diabetic ulcers are a serious concern because they can lead to severe complications, including infection and even amputation, if left untreated. People with diabetes should routinely inspect their feet for any signs of injury and seek prompt medical attention if they notice an ulcer forming.

See an image of a diabetic ulcer (foot) at the bottom of this blog.

When to Seek Medical Attention

It's crucial to identify and treat leg ulcers early to avoid complications such as infection, delayed healing, or more severe outcomes like amputation. If you notice any of the following, it's time to consult a healthcare professional:

• An open sore on your leg or foot that isn't healing or seems to be getting worse.
• Swelling, redness, or signs of infection around the wound.
• Severe pain, especially if it worsens with movement or leg elevation.
• Any changes in skin color, temperature, or hair loss on your legs or feet.

Leg ulcers, whether venous, arterial, or diabetic, are a sign of underlying health issues that must be addressed. The sooner you seek medical advice, the better your chances of successful treatment and recovery.

Taking the Next Step: Prioritize Your Leg Health!

Understanding the differences between venous, arterial, and diabetic ulcers is the first step toward getting the right treatment and improving your quality of life. Early intervention can prevent further damage, speed up healing, and improve your overall health. The longer you wait, the more likely complications, like infections or even amputations, can occur.

At Center for Vein Restoration, we specialize in diagnosing and treating venous diseases that lead to leg ulcers. With expertise in the latest, minimally invasive treatments, we are here to help you take control of your leg health.

Our team of industry experts is ready to provide you with the care and solutions you need to get back to living pain-free. Don't let leg ulcers control your life—reach out to the leaders in vein care today!

Contact the Center for Vein Restoration today to schedule a consultation. Call 240-965-3915 to speak to a helpful Patient Services Representative or schedule your consultation online at a CVR near you.

CVR accepts many insurances, including Aetna, Amerigroup, Anthem, Blue Cross/Blue Shield, Cigna, MultiPlan, Medicaid, Medicare, and more.