What it is
A venous ulcer is a leg wound linked to poor blood return from the legs to the heart. When the vein valves don't work well, blood can pool, pressure builds, and swelling and skin changes may follow. These ulcers often appear on the lower leg, near the ankle.
An arterial ulcer is linked to reduced blood flow into the leg or foot. With too little blood arriving, tissue may not get the oxygen and nutrients it needs to stay healthy or repair itself. These ulcers often show up on the toes, heels, or other pressure points, and the area may feel cool or painful.
Because the two types come from opposite circulation problems, they can look and feel different, but not always clearly. A leg ulcer can also have mixed causes or other contributors, such as diabetes or pressure. That is why a leg ulcer that won't heal is best looked at by a licensed professional rather than judged by appearance alone.
How it’s traditionally been approached
Care usually begins with an evaluation of the wound and the circulation in the leg. This may include a history, a physical exam, checking pulses, and vascular testing that measures blood flow in the arteries and veins. The results help clinicians identify what is driving the ulcer.
For venous ulcers, approaches have traditionally centered on compression therapy, edema management, wound cleaning, and appropriate dressings. Wound debridement, which is the removal of unhealthy tissue, is sometimes part of care. Compression is not suitable for everyone, which is why testing comes first.
For arterial ulcers, the focus has traditionally been on restoring or assessing blood flow, often with input from a vascular specialist, along with careful wound protection. Compression can be harmful when arterial flow is poor, so the distinction matters. Other options, such as negative pressure wound therapy, skin substitutes, or hyperbaric oxygen for certain FDA-cleared indications, are decisions for a licensed clinician after evaluation.
How the right wound care specialist may help
The right wound care specialist may help by working out which type of ulcer you have and what is contributing to it. A visit generally includes a conversation about your health history and symptoms, a close look at the wound, and an assessment of circulation. The specialist may coordinate with vascular, primary care, or other providers.
Specialists may also measure and document the wound over time so changes can be tracked. Depending on the findings, they may discuss options such as compression, debridement, dressings, or swelling management. Whether any of these is appropriate is for a licensed clinician to decide after an evaluation.
Questions worth asking: What is causing my ulcer, and is it venous, arterial, or mixed? Do I need a vascular evaluation first? What are my treatment options, and what are the risks of each? How long might healing take, and what signs mean I should call you? What does my insurance cover?
The whole-person view
Chronic leg wounds affect the whole person. Pain, poor sleep, limited mobility, and the frustration of a wound that won't heal can raise stress, and stress can in turn affect rest, activity, and overall well-being. Body, mind, and daily habits all influence each other.
Some people find extra support helpful alongside medical care. Somatic Experiences offers body-based support for stress and tension, and Therapists.plus can connect people with talk therapy for coping with the emotional side of long-term health challenges. These are complements to, not substitutes for, wound care from a licensed provider.
Somatic Experiences: trauma and emotional healing →Somatic Experiences: embodiment and movement →Therapists.plus: mind body connection →
Keep in mind
- Seek medical care promptly for signs of infection: spreading redness, red streaking, increasing warmth or pain, pus, foul odor, fever, or chills, or if a wound is rapidly worsening.
- Call 911 or go to the ER for heavy bleeding, exposed bone or tendon, signs of sepsis, or a deep or severely contaminated wound.
- Venous and arterial ulcers need different care, and compression may be unsafe with poor arterial flow, so only a licensed clinician should decide what is appropriate for you.
- Skin substitutes and amniotic or placental grafts vary in FDA status and coverage; most are regulated as minimally manipulated tissue, not FDA-approved drugs. Ask your provider, and see amnioticdoctors.com for further reading on amniotic products specifically.
Venous and arterial ulcers are treated very differently — a vascular evaluation tells them apart.
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Frequently asked questions
What is the difference between a venous ulcer and an arterial ulcer?
A venous ulcer is linked to poor blood return from the leg, while an arterial ulcer is linked to reduced blood flow into the leg or foot. They tend to differ in location, appearance, and symptoms, but a vascular evaluation is how clinicians tell them apart. Because treatment differs, a professional diagnosis matters.
Why won't my leg ulcer heal?
A leg ulcer may be slow to heal because of an underlying circulation problem, ongoing swelling, infection, pressure, or other health conditions. A wound care specialist can evaluate the cause, which is often the key to understanding the delay. Ask your provider about your wound's cause, staging, and expected healing time.
What is compression therapy for leg ulcers?
Compression therapy uses wraps or specialized garments to apply pressure to the leg, and it is traditionally used for venous ulcers to help manage swelling. It is not safe for everyone, especially people with reduced arterial blood flow. A licensed clinician should decide if it is appropriate after an evaluation.
What is a vascular evaluation for a leg wound?
A vascular evaluation is an assessment of the blood flow in your arteries and veins, often including a physical exam and noninvasive testing. It helps clinicians determine whether a wound is venous, arterial, or mixed. Your provider can explain which tests make sense for you.
Can a wound care specialist help with venous and arterial ulcers?
A wound care specialist may help by evaluating the ulcer, coordinating vascular testing, and discussing options such as compression, debridement, dressings, and edema management. Results vary by person and cause, and no outcome is guaranteed. Ask about treatment options, timelines, and insurance coverage.
When should I see a doctor about a leg ulcer?
See a licensed provider as soon as you notice an open sore on your leg or foot, especially if it isn't improving. Seek care promptly for spreading redness, streaking, pus, foul odor, increasing pain or warmth, fever, or chills. Call 911 or go to the ER for heavy bleeding, exposed bone or tendon, or signs of sepsis.
Educational resource. WoundKare shares general information and connects people with independent wound care specialists. It is not medical advice, diagnosis or treatment. Talk with a licensed professional about your health.