Leg Ulcers

Corona Phlebectatica Paraplantaris

This term literally means, “a crown of dilated veins around or near the foot.” The term is sometimes shortened to just Corona Phlebectatica. In the early stages, this may simply appear as a cluster of spider veins around the inner area of the ankle and foot. This is one of the earliest findings of venous insufficiency and an exam finding that may indicate underlying larger damaged veins even if there are no visible varicose veins. In the later stages, Corona Phlebectatica can appear as severely dilated, dark purple, spider veins (telangectasias) that surround the ankle and/or foot.

Hemosiderin Hyperpigmentation

Deposits of iron in the form of hemosiderin can result in localized brown discoloration of the skin when there are long-standing varicose veins and diffuse brown discoloration starting in the lower part of the leg when there is chronic venous insufficiency. Hemosiderin Hyperpigmentation gives the appearance of brown veins in the leg.

Atrophie Blanche

This term means white areas that are wasting away. Atrophie blanche appears as areas of white scars or ivory-white plaques in the skin that may be slightly depressed and surrounded by redness or pigmentation.

Venous Dermatitis

This itchy dermatitis is red and scaly and can arise as discrete patches or affect the leg circumferentially. In more severe cases, it may ooze, crust and crack.

Corona Phlebectatica Paraplantaris

This term literally means, “a crown of dilated veins around or near the foot.” The term is sometimes shortened to just Corona Phlebectatica. In the early stages, this may simply appear as a cluster of spider veins around the inner area of the ankle and foot. This is one of the earliest findings of venous insufficiency and an exam finding that may indicate underlying larger damaged veins even if there are no visible varicose veins. In the later stages, Corona Phlebectatica can appear as severely dilated, dark purple, spider veins (telangectasias) that surround the ankle and/or foot.

Lipodermatosclerosis

There can be several skin changes associated with Lipodermatosclerosis. The changes in skin color can include pink, red and purple discoloration which eventually turns brown. The skin may become thickened, hardened, tight, and smooth. These areas often become painful. Signs and Symptoms of Venous Ulcers:

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  Redness and swelling often present
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  Typically occur around the gaiter area (bony spots of the ankles)
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  Can be big or small
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  Often drain fluid
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  Can be painful, but often look a lot worse than you would expect them to feel
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  You may or may not have visible varicose veins or leg swelling

Arterial Ulcers

Arterial ulcers are the second most common cause of ulcers in the legs, accounting for about 15% of cases. Their cause is related to the arteries and is the opposite of problem with venous ulcers. Arteries carry oxygen and nutrient rich blood to the tissues. When you experience a blockage in the arteries (just like in a heart attack) that blood can’t get to the tissues. This causes the tissues to die, or experience necrosis.

Smoking is one of the biggest risk factors to developing problems with your arteries. Smoking causes plaque build up in your arteries and causes them to get smaller. Smaller arteries mean less blood flow. This is equivalent to suffocating your tissues.

Signs and Symptoms of Arterial Ulcers:

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  Often quite painful
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  Pale skin
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  Pain may be worse at night
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  Usually deep with a “punched out” look
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  Rarely have drainage
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  Walking makes your leg hurt worse, but putting your foot or leg in a dependent position (below your heart, like dangling off the side of the bed) helps to relieve the pain

Treatment of arterial ulcers usually requires surgery with a vascular surgeon to help restore normal blood supply to the area.

Diabetic Ulcers

It is estimated that 5% of ulcers are related to diabetes. Diabetic ulcers vary slightly in their cause, as it is related to high blood sugar levels instead of being caused from improper circulation. Diabetes is when you have abnormally high levels of blood sugar in your blood stream. This is caused either from your body’s inability to 1) make insulin, or 2) use insulin properly. Insulin acts like a “key” that allows glucose (sugar) entry into the individual cells. Glucose is the fuel, or energy source, for your cells. When insulin isn’t available glucose wanders around banging on your cell’s locked doors. In the process all this excess glucose starts damaging your fragile tissues (the micro-circulation), causing irreparable destruction.

Due to this repeated damage over time you start to lose feeling, especially in your feet. This puts you at risk of developing sores, or ulcers, on your feet from repeated trauma. A known culprit is poor fitting footwear. Regular foot exams by your provider can help detect early signs of damage.

Signs and Symptoms of Diabetic Ulcers:

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  May be calloused blisters, or red/black in color
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  Often painless, unless an infection is present
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  Wound may look macerated

Treatment may include debridement (removal of dead tissues), treatment with antibiotics if an infection is present, and good wound care to help keep the wound bed clean to facilitate healing. Properly fitting shoes, not walking around barefoot, and regular foot examinations to assess for damage are essential. In addition, maintaining your diabetes and keeping your blood sugar in control is vital to help with healing and prevent further damage.