Arterial leg ulcers

Overview

An arterial leg ulcer is a slow-healing sore on your leg or foot that happens because the arteries (blood vessels that carry oxygen-rich blood from your heart to the rest of your body) become narrowed or blocked. This reduces blood flow to the skin, so even a tiny cut can turn into a wound that does not heal properly.

Arterial leg ulcers are less common than venous ulcers, but they still affect many people, especially older adults and those with circulation problems.

They most often affect people over 60, smokers, and individuals with conditions like diabetes, high blood pressure, or peripheral artery disease (narrowing of arteries in the legs).

Symptoms

Common symptoms

• A wound on your leg, ankle, or foot that is slow to heal or does not heal at all
• The skin around the wound may look pale, shiny, or cool to the touch
• Pain in the leg, especially at night or when you raise your leg (pain may ease when you dangle your leg down)
• The affected leg may feel colder than the other leg

Symptoms in children

• Arterial leg ulcers are very rare in children. If they occur, it is usually due to a serious underlying condition like a blood vessel problem or severe injury.

Symptoms in older adults

• Older adults may have the same symptoms but may also have other circulation problems, like cold feet, weak pulses, or brittle toenails.
• Because skin is thinner, even a small bump can lead to an ulcer.

Causes

Main causes

• Atherosclerosis (hardening and narrowing of the arteries) – often due to plaque buildup from cholesterol and fat
• Peripheral artery disease (PAD) – reduced blood flow to the legs and feet
• Blood clots that block an artery

Risk factors

• Smoking or using tobacco products
• Diabetes (high blood sugar can damage blood vessels)
• High blood pressure
• High cholesterol
• Being over age 60
• Obesity
• Lack of physical activity

When to see a doctor

See a doctor urgently if:

• If you have any sudden, severe leg pain or your leg becomes cold and pale, get emergency help right away.
• If the ulcer shows signs of infection (redness spreading, pus, fever) see a doctor urgently.

Book a routine appointment if:

• If you have a sore on your leg or foot that has not healed after two weeks
• If you notice your leg is always cold, or you have leg pain when walking that goes away when you rest

Diagnosis

A doctor will examine your leg, feel the pulses in your feet, and ask about your symptoms and medical history. They may also use tests to check blood flow.

Tests that may be done

• Ankle-brachial index (ABI) – compares blood pressure in your ankle and arm to see how well blood flows to your legs
• Doppler ultrasound – uses sound waves to create images of blood flow in your arteries
• Blood tests – to check for diabetes, high cholesterol, or other conditions

What to expect at your appointment

The tests are painless and non-invasive (they do not involve needles or cutting). You may be asked to lie down while a blood pressure cuff and a small handheld device are used on your legs and arms.

Treatment

Treatment focuses on improving blood flow to the leg, keeping the wound clean and covered, and managing any underlying conditions that affect your circulation.

Self-care at home

• Keep the wound clean and dry, and follow your healthcare provider's instructions on how to change the dressing
• Do not smoke – smoking narrows your arteries and makes healing much slower
• Stay active as much as possible – gentle walking can help improve circulation if it is not painful
• Keep your leg warm but avoid direct heat (like heating pads) because you may not feel burns due to poor circulation

Medical treatments

Your doctor may prescribe special wound dressings to help the ulcer heal. They may also recommend treatments to improve blood flow, such as medications that help widen the arteries or control blood pressure and cholesterol. In some cases, a procedure called angioplasty (where a tiny balloon opens up the narrowed artery) or surgery might be needed. Always follow your healthcare provider's plan exactly as they recommend.

When is surgery considered?

If the blockage in the artery is severe and does not improve with other treatments, a surgeon may perform a bypass operation (creating a new pathway for blood to flow around the blocked area). This is usually only considered for serious cases.

Living with this condition

Living with an arterial leg ulcer requires daily attention to wound care and lifestyle habits. You will likely need to change the dressing regularly and keep the area clean. Pain management is also important – your doctor can suggest safe ways to reduce discomfort.

Lifestyle tips

• Quit smoking – this is the single most important thing you can do to help heal the ulcer
• Stay physically active within your limits – even gentle movement helps circulation
• Manage your blood pressure, cholesterol, and blood sugar if you have diabetes
• Avoid crossing your legs for long periods, as this can reduce blood flow

Diet and exercise

Eating a balanced diet with plenty of fruits, vegetables, and whole grains supports overall health and wound healing. Some people may benefit from eating more protein to help repair tissue. Regular exercise like walking or leg exercises can improve circulation – but check with your doctor first if exercise causes pain.

Mental health and emotional wellbeing

Having a chronic wound can be frustrating and stressful. You may feel anxious or down about the healing process. It's normal to have these feelings, and talking to a healthcare provider or counselor can help. If you feel overwhelmed, tell your doctor.

Prevention

You can reduce your risk of developing an arterial leg ulcer by managing the conditions that narrow your arteries – especially not smoking, controlling blood pressure and cholesterol, eating well, and staying active. If you already have peripheral artery disease, careful foot care and regular check-ups can prevent small injuries from becoming ulcers.

Complications

If left untreated

• Infection that can spread to the bone (osteomyelitis) or throughout the body (sepsis)
• Tissue death (gangrene) that may require amputation of a toe, foot, or part of the leg
• Chronic pain and limited mobility

Long-term outlook

With proper treatment and self-care, many arterial leg ulcers can heal. Healing may take several weeks or months, but the outlook improves when you stop smoking, manage your health conditions, and follow your treatment plan closely. Even if an ulcer does not fully heal, you can prevent it from getting worse and avoid serious complications.

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