The evaluation of lower-extremity ulcers

Abstract

Lower-limb ulceration is prevalent in Western countries. There are many different types of ulcers with several causes. The most prevalent are those due to vascular disease, of which venous is the most common, accounting for over two-thirds of all types of ulcers. There are also many other causes for ulceration such as malignancy, infections, and skin, drug-induced, and autoimmune diseases. The ulcers have different characteristics, which may be differentiated by the history and clinical examination of the patients. However, objective documentation for the ulcer etiology is necessary prior to instigating treatment. The methods for diagnosing the causes for the ulcers include plethysmography, ultrasound, angiography, computer tomography, magnetic resonance imaging, and skin biopsy. All these tests should be used in conjunction with the clinical presentation of the patient. They should be performed in a cost-effective manner to avoid delays in diagnosis and reduce costs and usage of resources.

Keywords: Lower-limb ulcers; clinical examination; diagnostic tests.

Figure 1

Venous ulcer in the medial calf of the right lower extremity. The patient had chronic venous disease of over 15 years in duration. Prolonged reflux was found in the great saphenous vein and in many thigh and calf tributaries. Multiple perforator veins were dilated and incompetent in the calf.

Figure 2

Tissue loss with gangrenous and ulcerative changes in the big toe of the right lower extremity. The patient had multilevel arterial disease involving the pelvic thigh and calf arteries.

Figure 3

Differential diagnosis for lower-limb ulceration.