Leg ulcers are a massive problem for people all over the globe. Having the right diagnosis for the type of ulcer you have is really important as the wrong treatment can be detrimental. In a previous article we have discussed venous ulcers; however, there are many other types such as arterial, diabetic and rheumatic ulcers. In this article, we will be focusing on arterial (also known as ischemic ulcers) which is caused by insufficient tissue perfusion.
Arteries carry nutrition and oxygen around the body to where it is required. Arterial ulcers are caused by poor delivery of blood to the lower extremities such as your legs and feet. As the tissue in this area is deprived of nutrition and oxygen, it dies and causes open wounds. Additional wounds already there from trauma such as a fall, fail to heal and can develop into an arterial ulcer.
Risk factors
There are many risk factors for developing arterial ulcers. People with peripheral vascular diseases are more prone due to the restrictions to the blood vessels meaning the oxygen and nutrition cannot get to the tissues where it is needed. People with diabetes are also more at risk and those who previously smoked mainly due to smoking clogging the arteries, causing abnormal perfusion to the extremities. Obesity due to atherosclerosis – the thickening of the arteries due to the buildup of fatty materials – and arteriosclerosis – the hardening of the arteries – also increases your risks. Additionally, as your age increases, your arteries do not work as well as they used to, increasing your risk of arterial leg ulcers.
Signs of an arterial leg ulcer
The ulcers wounds often have a deep punched appearance which is usually round in shape. The wound bed is mostly yellow (slough), brown, grey or black in colour and does not easily bleed. They are often found on the outer ankles and around the toe area due to footwear rubbing.
One of the noticeable signs of an arterial leg ulcer is that it is almost always painful. Sometimes this pain is more intense when sleeping at night in bed, and is relieved when you hang your feet over the side of the bed. Additionally, intermittent claudication (caused by narrowing or a blockage in the main artery taking blood to your leg) is noted during activity which is only relieved at rest.
Diagnosis
Diagnosis of an arterial leg ulcer should be undertaken by a healthcare professional. Firstly it needs to be assessed if you have problems with your arteries. This can be identified by testing the pulses in your legs. Undertaking a doppler test can assist with this, and if arterial problems are indicated, then a test called an angiogram is used to evaluate your blockage. You will then be referred on for further investigations.
Additionally, to assist with the diagnosis, you can look at the legs to see if they are showing signs of arterial problems. The skin to the legs can appear cold, a red/blue discolouration and a decrease of leg hair growth due to the lack of nutritious blood and oxygen brought to the area. The nails are typically thickened and ridged. There is delayed capillary return (the colour coming back to lightly compressed skin by the fingertips) in the affected area.
How you can reduce the healing time
After diagnosis, in order to treat the arterial leg ulcer, the primary goal is to increase the blood flow to the area. This helps bring the nutrition and the oxygen required to heal the arterial leg ulcer. A health care professional can determine the best way to manage or restore your circulation. This can be done surgically by carrying out an angioplasty which helps open narrowed arteries by compressing the plaque with a thin flexible tube called a catheter which has a balloon on the end. Atherectomy does the same as an angioplasty however instead of compressing the plaque, it removes the plaque. Or it can be treated by a stent which opens the artery. In extreme cases, amputation may be required.
Additional things you can do to decrease the healing time of your arterial leg ulcer is to:
- Avoid crossing legs while sitting as this can reduce your circulation further.
- Try and avoid being cold as this can reduce your blood flow to your extremities.
- Quit smoking as this is a major contribution to arterial leg ulcers as mentioned above.
- Ensure that you monitor your blood pressure and keep it in a healthy range for you.
- Follow a low cholesterol diet.
- Keep active; there are many fun ways to keep fit.
To assist with wound healing, a balanced diet is required. Proteins are needed for tissue construction, carbohydrates are needed for energy to rebuild the cells, fats are needed for energy to regenerate tissue, vitamins and trace elements. A balanced diet can help you lose weight if you are obese which again will help decrease healing time and reduce your risk of developing an arterial leg ulcer.
This post should have helped you understand more about arterial leg ulcers, reduce the risk of developing arterial leg ulcers and decrease their healing time. With good wound treatment and working closely with your health care professional, hopefully, you can decrease the healing time of your arterial leg ulcer.
