Characteristic | Arterial ulcer* | Venous ulcer | Neuropathic ulcer* |
Location | Over toe joints, malleoli (over the bony prominence), anterior shin, base of heel, pressure points | Medial and lateral malleolar area above bony prominence, posterior calf, may be large, circumferential | Plantar surface of foot over metatarsal heads, heel, pressure points |
Appearance | Irregular margins, base dry and often pale or necrotic (brown/black fibrous tissue) | Irregular margins, pink or red base that may be covered with yellow fibrinous tissue, exudate common (may be heavy); ulcers can be large, sometimes circumferential | Punched out ulcer, usually superficial but sometimes deep, red base |
Ulcer within callus | Rare | No | Calloused border, ulcer can be underlying a callus |
Foot temperature | Warm or cool | Warm | Warm |
Pain | Yes, may be severe | Yes, usually mild but may be severe | No |
Arterial pulses | Absent | Present | Present or absent |
Sensation | Variable | Present | Absent tactile, pain, temperature and vibratory sensations |
Foot deformities | No | No | Often |
Skin changes | Shiny, taut, loss of hair Dependent rubor of leg and foot that becomes pale with leg elevation | Erythema, brown-blue hyperpigmentation can be spotty or diffuse: "stasis" changes; atrophie blanche (white sclerotic areas), edema; dry skin; varicose veins common; if lipodermatosclerosis is present, skin may be bound down; bilateral lower extremities often affected | Waxy or shiny, loss of hair, may be taut; dry skin; may have non-pitting edema, especially on dorsal foot |
Reflexes | Present | Present | Absent |