DIFFERENTIAL-DIAGNOSIS - ASSESSMENT OF THE LOWER-EXTREMITY ULCER - ISIT ARTERIAL, VENOUS, NEUROPATHIC

A non-healing ulcer of the lower extremity may be multifactorial in or igin. The classic description includes: an ulcer superior to the media l malleolus usually indicating venous disease; ulceration of the anter ior tibial surface as reflective of blood dyscrasias; ulcers at areas of pressure that may or may not be related to neuropathy, especially w ith diabetes mellitus; and ulceration of the toe and heel that are art erial. These descriptors are best used as starting points for identify ing the cause of these lesions. The most important information is acqu ired through a thorough patient history and physical examination. Non- invasive testing is a valuable and necessary adjunct; invasive testing is often required before definitive or palliatlve therapy, especially in ulcers of arterial origin.