Summary
Reduced blood supply to the legs deprives the peripheral tissues of oxygen-rich arterial blood and may cause painful ulcers to form on the toes. Buildup of cholesterol plaques (atherosclerotic disease) in the arteries of the leg is the most common cause. Other diseases such as sickle cell disease and diabetes may also lead to ulcer formation. Arterial ulcers that won’t heal require surgery to restore blood flow. Along with surgery, stopping smoking and ensuring good control of blood sugars (diabetes), cholesterol, and blood pressure are key to maintain good arterial circulation.
Clinical Presentation
Arterial ulcers result from decreased arterial blood supply to the legs. The arterial blood is the oxygen-rich blood that leaves that the heart pumps out to the brain, vital organs, and the extremities. Reduced blood flow deprives peripheral tissues of oxygen that can lead to local tissue death. The most common cause of arterial ulcers is the buildup of cholesterol plaques in the large and medium arteries of the legs. Atherosclerotic disease is most common in men over 45 and women over 55.
Factors to decrease risk of atherosclerotic disease include:
- Stopping smoking
- Controlling blood pressure
- Controlling blood sugar for diabetics
- Lowering cholesterol
- Maintaining a healthy weight
- Other risk factors for the development of arterial ulcers include diabetes, sickle cell disease, and vasculitis.
Arterial ulcers usually present on the toes as this is the area farthest away from the heart and therefore most often effected by decreased arterial blood flow. This is in contrast to many diabetic ulcers secondary to a decreased sensation (peripheral neuropathy) which often form over bony prominences on the sole of the foot. In patients with arterial ulcers the affected limb is often painful at rest due to insufficient flow of oxygen-rich arterial blood The arterial ulcer will also likely be painful. Gangrene (death of local tissue with an associated infection) of the foot may also occur.
Treatment
Surgical revascularization is indicated for non-healing ulcers. The narrowing of the artery can either be expanded, bypassed, or replaced. Patients should also stop smoking and improve control of their blood pressure, cholesterol, and diabetes.
Walking can help with the revascularization process. Sleeping in a chair helps improve the pain experienced at rest.
Edited July 5th, 2021