Assessing Arterial Ulcers Protection Status

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Arterial ulcers can cause much pain for patients and consternation for the wound care professionals tasked with managing them. Arterial ulcers can be a catch-22 in that many patients with arterial ulcers present with edema, but due to the nature of their problem cannot be safely compressed.

Management of arterial ulcers starts with recognition of the problem. Identifying arterial disease can be tricky but is crucial - failure to recognize the presence of arterial disease can have serious consequences for the patient.

Arterial ulcers typically appear on the foot (dorsum, lateral malleolus) or toes. They may appear where an area of pressure is present. You may note that the affected leg and foot are pale, cool to touch and hairless. Pulses may be absent or diminished. There may be dependent edema of the affected limb, and blanching on elevation of the limb may be noted. The ulcer itself often has a "punched out" appearance and may be deep or shallow; necrotic tissue may be present. The wound may lack granulation tissue and the wound base is often pale.1 The patient may complain of pain in the affected limb during exercise and/or upon elevation of the extremity. Pain may also occur at rest and is often relieved when the limb is placed in a dependent position.

You will want to obtain the patient’s history, which may include smoking, peripheral vascular disease, diabetes, obesity, dyslipidemia, and/or hypertension. Ask the patient about their mobility and activity level. Query the patient regarding adequacy of their diet and assess nutritional status. Assess pain and any issues with performance of ADLs/quality of life. Ask about previous episodes of ulceration and previous treatments. The wound should be assessed in the same manner as all wounds.

Ankle-brachial index (ABI) is used to measure peripheral tissue perfusion. When pulses are difficult to palpate, Doppler ultrasound can be used. Diagnosis of an arterial ulcer is made through a combination of the patient’s history, appearance and characteristics of the wound and the ABI results. The lower the ABI result, the more likely it is that the patient might require a revascularization procedure or amputation.2

1. Hess C. Arterial ulcer checklist. Advances in Skin & Wound Care. 2010;23(9): 432.
2. Meyers B. Wound Management (2nd edition). Upper Saddle River, New Jersey: Pearson Prentice Hall; (2008): 234.

About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of, and advocate of incorporating digital and computer technology into the field of wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

Recommended for You

  • October 22nd, 2020

    Holly Hovan MSN, APRN, RN-BC, CWOCN-AP

    Identifying wound etiology before initiating topical treatment is important. Additionally, correctly documenting wound etiology is significant in health care settings for many reasons. Accurate documentation and appropriate topical treatment...

  • January 31st, 2021

    Up to 20% of all US medicolegal claims and more than 10% of settlements are wound related. Documentation is essential for all health care settings; however, there are differences in each setting. Knowing your clinical setting’s requirements from a documentation standpoint is critical in meeting...

  • January 24th, 2020

    By the WoundSource Editors

    The most common type of chronic lower extremity wound is the venous ulcer, affecting 1% to 3% of the U.S. population. Chronic venous ulcers significantly impact quality of life and are a financial burden for both the patient and the health care...

Important Notice: The contents of the website such as text, graphics, images, and other materials contained on the website ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The content is not intended to substitute manufacturer instructions. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Refer to the Legal Notice for express terms of use.