Two Leg Ulcers That Look Alike and Need Opposite Care
How we tell venous from arterial ulcers at our Homewood, Mokena and South Chicago Heights offices
A leg ulcer is not a diagnosis. It is a description of what you can see. Before anyone decides how to treat it, someone has to answer a more basic question: is blood struggling to get out of this leg, or struggling to get in? Those are two different diseases that happen to produce a similar looking hole in the skin.
Getting that answer wrong is not a minor error. The core treatment for one type is actively harmful in the other. This page walks through how the two differ, what testing settles it, and what each one needs.
Medically reviewed by Dr. Timothy Horak and Julia Shauger, board-certified podiatric specialists serving Homewood, South Chicago Heights & Mokena. Last reviewed July 2026.
Side by Side
| Feature | Venous ulcer | Arterial ulcer |
|---|---|---|
| Underlying problem | Blood cannot drain out of the leg | Blood cannot get into the leg |
| Where it sits | Inner ankle, lower shin | Toes, heel, outer ankle, between toes |
| Shape | Shallow with sloping irregular edges | Deep with sharp punched-out edges |
| Wound bed | Red and granulating, or yellow film | Pale, grey, or black dead tissue |
| Drainage | Wet, often soaks the dressing | Dry, very little drainage |
| Pain pattern | Aches, eases when the leg is elevated | Severe, eases when the leg hangs down |
| Surrounding skin | Brown staining, swelling, varicose veins | Pale, shiny, hairless, cool to touch |
| Foot pulses | Usually present | Weak or absent |
| How common | The most common type of leg ulcer | Less common, but more urgent |
| Main treatment | Compression to clear the backed-up pressure | Restoring blood flow to the limb |
| Is compression safe | Yes, it is the treatment | No, it can make the wound worse |
Use this to understand the difference, not to diagnose yourself. Plenty of real wounds sit somewhere between these two columns, and that is exactly the situation where testing matters most.
The most useful clue is what elevation does. Put your leg up on a pillow. If the ache settles, that points venous, because you have just helped the blood drain. If the pain gets worse and you find yourself hanging the leg off the side of the bed to relieve it, that points arterial, because gravity was the only thing pushing blood down to the toes. Patients often figure this out on their own before they ever come in.
Venous Ulcers
What is going on
The one-way valves in the leg veins stop closing, so blood slides back down and pools around the ankle. Pressure builds, fluid pushes out into the tissue, and the skin gradually gives way. It is a slow process, usually years, with swelling and brown staining long before anything opens.
- • A previous deep vein clot
- • Varicose veins
- • Years of standing work
- • Higher body weight
What it needs
- • Compression, applied correctly, as the primary treatment
- • Debridement of dead tissue and the rolled wound edge
- • Absorbent dressings, since these wounds are wet
- • Elevation and calf exercise to work the muscle pump
- • Assessment of the underlying veins so it does not recur
Arterial Ulcers
What is going on
Peripheral artery disease narrows the vessels feeding the leg, so tissue at the far end runs short of oxygen. A small knock, a tight shoe or a trimmed callus is enough to open a wound that then has no fuel to close. Many people notice calf cramping when walking for months or years beforehand.
- • Smoking, the single biggest factor
- • Diabetes
- • High blood pressure and cholesterol
- • Older age
What it needs
- • Vascular assessment before anything else
- • Restoring blood flow where possible, by angioplasty, stent or bypass
- • Wound care that keeps the tissue protected in the meantime
- • Stopping smoking, which changes the outlook more than any dressing
- • Compression avoided or heavily modified
Arterial ulcers carry more urgency. A venous ulcer that waits a month is harder to heal. An arterial ulcer that waits a month can cost tissue. If a wound on your toe or heel is dry, painful and not changing, that is worth a call this week rather than next month.
When It Is Both
A meaningful share of leg ulcers have a venous and an arterial component together. These mixed ulcers are the reason we test rather than assume. The venous side is asking for compression and the arterial side is limiting how much compression the leg can tolerate, so the answer is a judgment call based on measured blood flow, not on how the wound looks.
Modified, lighter compression is sometimes appropriate for a mixed ulcer, but only with the arterial numbers in hand and with the leg watched closely. Full compression on a leg with significant arterial disease is the one thing we will not do.
What to Realistically Expect
The first visit is mostly about sorting out which problem you have. That means history, a look at the wound and the skin around it, feeling for pulses, and an ankle-brachial index. Sometimes the answer is clear that day. Sometimes it takes an ultrasound or a vascular referral before we commit to a plan, and we would rather take the extra step than start compression on the wrong leg.
We will not give you a healing timeline at that first visit. What we will give you is a clear answer on what type of wound this is, what the next test or treatment is, and what to watch for at home in the meantime.
Common Questions
What is the difference between a venous and an arterial ulcer?
A venous ulcer is a drainage problem. Blood gets into the leg fine but cannot get back out, so pressure builds and the skin around the inner ankle breaks down. An arterial ulcer is a supply problem. Not enough blood is reaching the tissue in the first place, so a minor scrape on a toe or heel never heals. Venous ulcers are shallow, wet and ache less when the leg is up. Arterial ulcers are deep, dry and hurt more when the leg is up.
Why does it matter which type of ulcer I have?
Because the main treatments point in opposite directions. Compression is essential for a venous ulcer, since squeezing the leg is what clears the backed-up pressure. That same compression on a leg with poor arterial flow squeezes shut the little circulation the tissue still has and can turn a small wound into a serious one. Guessing is not safe, which is why circulation gets checked before any wrap goes on.
How do doctors tell venous and arterial ulcers apart?
It starts with where the wound sits and what it looks like, then moves to objective testing. We feel for pulses in the foot and measure an ankle-brachial index, which compares blood pressure at the ankle with blood pressure in the arm. A low reading points to arterial disease. Duplex ultrasound can map both the veins and the arteries when the picture is unclear. The exam narrows it down, the testing confirms it.
Can you have both types at once?
Yes, and it is more common than people expect, especially in older adults and smokers. That combination is called a mixed ulcer. It is treated carefully, because the venous side needs compression and the arterial side limits how much compression is safe. Mixed ulcers are not something to manage at home with drugstore wraps. They need testing first and supervised treatment after.
Related Reading
Specialized Wound Care at ASG Foot & Ankle
Our board-certified podiatrists treat slow-healing wounds, diabetic foot ulcers, and post-surgical wounds at our three clinics in Homewood, South Chicago Heights, and Mokena.
Swelling that stops going down?
Ordinary swelling clears overnight. When it does not, the skin becomes the problem to solve.
Lymphedema in the Legs and Feet →Still walking on the ulcer?
Pressure is what keeps a foot ulcer open. Why the device you cannot remove beats the boot you can.
Offloading a Foot Ulcer →Swelling that came years before the skin broke down? Swollen Feet and Ankles: One Leg or Two? →
See a Podiatrist Near You
ASG Foot & Ankle has offices in Homewood, South Chicago Heights and Mokena. Our board-certified podiatrists accept most insurance. Find the office closest to you:
Find Out Which Type You Have
Circulation testing is quick, painless, and it decides everything that follows. Our podiatrists assess leg ulcers at three offices in Homewood, Mokena and South Chicago Heights, and most major insurance is accepted.