OBJECTIVE. The purpose of this study was to describe the types of peri
osteal reaction seen in response to long-standing leg ulcers and to di
fferentiate the types associated with osteomyelitis. MATERIALS AND MET
HODS. Over a IO-year span, we retrospectively evaluated the radiograph
s of 20 patients with lower leg soft-tissue ulceration and adjacent pe
riosteal bone reaction of the tibia or fibula. Two of us evaluated the
location and appearance of periosteal reaction, and one of us evaluat
ed the patients' medical records for evidence of peripheral vascular d
isease, systemic illnesses, and osteomyelitis. RESULTS. Twelve patient
s had organized periosteal reactions that resulted in the appearance o
f ulcer osteoma. None of these patients subsequently developed osteomy
elitis. Eight patients had interrupted lamellar nodular periosteal rea
ctions; six of the eight patients had superimposed osteomyelitis. CONC
LUSION. Our study showed two types of periosteal response to chronic l
eg ulcers: a solid organized type that over time formed an ulcer osteo
ma and a lamellar nodular type that was often associated with osteomye
litis. Both types of ulcers were seen in patients with peripheral vasc
ular disease, TV drug abuse, sickle cell disease, and neurologic impai
rment.