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N. Mariana S. Vasquez: Understanding the 3 Main Types of Leg Ulcers
N. Mariana S. Vasquez/X
Nov 6, 2026, 09:51

N. Mariana S. Vasquez: Understanding the 3 Main Types of Leg Ulcers

N. Mariana S. Vasquez, IMG Physician, shared a post on X:

“Stop mixing up: Arterial vs. venous vs. neuropathic ulcers!

All three can cause lower-extremity ulcers, but their location, appearance, and underlying mechanisms are different.

1. Arterial ulcers

  • Mechanism: Reduced arterial blood flow – tissue ischemia.
  • Location: Toes, feet, heels, and pressure points.
  • Appearance: Deep, sharply demarcated, often pale or necrotic.
  • Pain: Usually painful, especially at rest or with elevation.
  • Skin: Cool, shiny, hairless; diminished pulses.
  • Classic clue: Painful toe ulcer plus absent or diminished pulses.

2. Venous ulcers

  • Mechanism: Chronic venous hypertension due to venous insufficiency.
  • Location: Medial malleolus, especially the lower leg.
  • Appearance: Shallow, irregular borders, often with moderate to heavy exudate.
  • Pain: Usually aching or mild to moderate pain; improves with leg elevation.
  • Skin: Edema, hemosiderin deposition, and stasis dermatitis.
  • Classic clue: Edema plus brown skin discoloration plus medial ankle ulcer.

3. Neuropathic ulcers

  • Mechanism: Loss of protective sensation – repetitive unnoticed trauma and pressure.
  • Location: Plantar surface, especially metatarsal heads and heel.
  • Appearance: Punched-out ulcer, often surrounded by callus.
  • Pain: Often painless because of peripheral neuropathy.
  • Skin: May be warm, with preserved pulses if there is no coexisting PAD.
  • Classic clue: Diabetes plus loss of sensation plus painless plantar ulcer.

The easiest way to remember:

  • Arterial means blood cannot reach the tissue.
  • Venous means blood cannot return efficiently.
  • Neuropathic means patient cannot feel the injury.

USMLE high-yield pearls

  • Painful ulcer on the toes plus weak pulses – Arterial.
  • Medial ankle ulcer plus edema plus hemosiderin – Venous.
  • Painless plantar ulcer plus surrounding callus – Neuropathic.
  • Compression therapy is a cornerstone of venous ulcer treatment, but significant arterial disease must be assessed first.
  • Always evaluate for coexisting PAD in diabetic foot ulcers.

Don’t confuse the location, appearance, and mechanism!”

Other posts featuring N. Mariana S. Vasquez on Hemostasis Today.

Arterial ulcer Health Hematology Hemostasis Hemostasis News Hemostasis Today Medicine N. Mariana S. Vasquez neuropathic ulcer ulcers
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