What it is
A venous ulcer is an open sore that develops when the veins in the legs have trouble returning blood to the heart. Blood can pool in the lower leg, raising pressure in the tissue and skin. Venous ulcers are often described as appearing on the lower leg, near the inner ankle, and may come with swelling, skin darkening or itching.
An arterial ulcer is an open sore that develops when arteries do not deliver enough blood to the tissue, often called poor circulation or ischemia. Without enough blood flow, skin and tissue may break down and heal slowly. These ulcers are often described as appearing on the toes, heels, or other pressure points of the foot, and they may look dry, deep or punched-out, with surrounding skin that feels cool or looks pale.
Descriptions like these are general, and real wounds do not always follow the pattern. Some people have both vein and artery problems, and other conditions such as diabetes or pressure can also cause leg and foot wounds. That is why only a licensed clinician can determine what type of ulcer is present and what is causing it.
How it’s traditionally been approached
Clinicians have traditionally told these ulcers apart by taking a history, examining the wound and the surrounding skin, and checking things like swelling, skin changes, temperature and pulses in the foot. Pain patterns are also considered, since the two types are often described as feeling different.
Testing is often part of the picture. Providers commonly use circulation measurements, such as comparing blood pressure in the arm and ankle, and imaging such as ultrasound to look at blood flow in veins or arteries. Which tests are used depends on the person and the provider.
Approaches to care differ because the causes differ. Venous ulcers have traditionally been managed with attention to the wound dressing and to the vein-related pressure problem, while arterial ulcers have traditionally focused on blood supply and may involve vascular specialists. Because what helps one type can be unsuitable for the other, a proper evaluation matters before any approach is chosen.
How the right wound care specialist may help
The right wound care specialist may help by working out which type of ulcer you have, or whether more than one factor is involved. A first visit generally includes a conversation about your health history, medications, and how the wound started, followed by a look at the wound, the skin around it, and the circulation in your legs and feet. The provider may also measure and document the wound so changes can be tracked over time.
Depending on findings, a specialist may coordinate with other professionals, such as vascular specialists, primary care clinicians, or podiatrists. They may discuss dressing options, ways to protect the area, and possibly advanced options such as negative pressure wound therapy or other therapies when appropriate. Whether any of these are right for you is a decision for a licensed clinician after an evaluation.
Questions worth asking a licensed provider include: What is causing my wound? How is it staged or classified? What treatment options exist and what are the pros and cons? What is the expected healing time? Does my insurance cover the recommended care? What signs should prompt me to call you sooner?
The whole-person view
Long-lasting wounds can affect the whole person. Pain, interrupted sleep, limited mobility and worry about healing can raise stress, and stress can in turn affect rest, appetite and daily habits that support the body. Body, mind and stress influence each other, so caring for the whole person is a reasonable part of the conversation.
Some people find body-based support helpful for managing stress, such as the practitioners listed through Somatic Experiences. Others find talk therapy useful for coping with the frustration of a slow-healing wound, such as the therapists at Therapists.plus. These are complementary options to discuss alongside, never instead of, medical wound care.
Somatic Experiences: trauma and emotional healing →Somatic Experiences: embodiment and movement →Therapists.plus: mind body connection →
Keep in mind
- This page is educational only and is not medical advice; a licensed professional should evaluate any wound and guide your care.
- Seek medical care promptly for signs of infection, including spreading redness, red streaking, increasing warmth or pain, pus, foul odor, fever or chills, or a wound that 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.
- Do not assume a wound type on your own, since the treatment that suits one type may not suit the other; if you are in emotional crisis, call or text 988.
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Frequently asked questions
What is the main difference between an arterial ulcer and a venous ulcer?
The main difference is the cause: arterial ulcers are linked to poor blood delivery through the arteries, while venous ulcers are linked to trouble returning blood through the veins. This often leads to differences in location, appearance and symptoms. A licensed clinician must evaluate the wound to confirm which type it is.
Where do arterial and venous ulcers usually appear?
Venous ulcers are commonly described on the lower leg, often near the inner ankle, while arterial ulcers are commonly described on the toes, heels or other pressure points of the foot. These are general patterns and not rules. Only a provider can tell what is going on with a particular wound.
How can you tell an arterial ulcer from a venous ulcer?
Clinicians usually tell them apart through a history, a physical exam of the wound and surrounding skin, and circulation tests such as ankle-arm pressure comparisons or ultrasound. Looking at a wound alone is not reliable, so self-diagnosis is not recommended. A wound care specialist can arrange the right evaluation.
Is an arterial ulcer or venous ulcer more serious?
Either can be serious if left unevaluated, and the answer depends on the individual. Arterial ulcers involve reduced blood supply, which can make healing difficult and may need prompt attention from a vascular specialist. Ask a licensed provider about your wound's cause, staging and expected healing time.
Can a wound care specialist help with arterial ulcer vs venous ulcer care?
A wound care specialist may help by identifying the likely cause, documenting the wound, and coordinating care with other professionals when needed. What they recommend depends on your evaluation and health history. It is also fair to ask about treatment options and insurance coverage.
Do skin substitutes or other advanced therapies treat these ulcers?
Some advanced options, such as negative pressure wound therapy or skin substitutes, may be considered in certain cases, but only a licensed clinician can decide if they are appropriate. Skin substitutes and amniotic or placental grafts vary in FDA status, since most are regulated as minimally manipulated tissue rather than FDA-approved drugs, and coverage differs by product and payer. For more on amniotic products specifically, amnioticdoctors.com is available as further reading.
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.