Venous vs Arterial Ulcers: What’s the Difference and Why It Matters
If you're dealing with a slow-healing wound on your leg, it's easy to assume it's just a minor issue. But in reality, the underlying cause of that wound plays a huge role in how it should be treated. Two of the most common—and most serious—types of leg ulcers are venous ulcers and arterial ulcers. While they may look similar at first glance, they stem from very different circulatory problems and require very different treatments.
At American Surgeons Group in South Chicago, we specialize in accurate diagnosis and targeted treatment for chronic leg wounds. In this blog, we’ll break down the key differences between venous and arterial ulcers, why they matter, and how to know which one you or your loved one may be facing.
What Are Venous Ulcers?
Venous ulcers are the most common type of leg ulcer. They occur when the veins in your legs fail to properly return blood back to the heart—a condition called chronic venous insufficiency. This leads to increased pressure in the veins, causing fluid to leak out into the surrounding tissues, which eventually breaks down the skin and causes ulcers.
Common features of venous ulcers:
Typically appear around the inner ankle or lower leg
Skin around the ulcer may be discolored, swollen, or hardened
The wound is usually shallow with irregular edges
Often not very painful, unless infected
Legs may feel heavy or achy, especially after standing
Venous ulcers tend to develop slowly and can become chronic if not properly treated.
What Are Arterial Ulcers?
Arterial ulcers (also known as ischemic ulcers) result from poor blood flow through the arteries, often due to peripheral artery disease (PAD). This lack of oxygen-rich blood causes the skin and underlying tissues to break down.
Common features of arterial ulcers:
Typically found on the feet, toes, heels, or outer ankle
The wound often has a "punched-out" appearance with well-defined edges
The skin around the ulcer may appear cool, pale, or shiny
These ulcers are often very painful, especially at night or when legs are elevated
There may be little to no bleeding, due to restricted blood flow
Unlike venous ulcers, arterial ulcers can worsen rapidly and may signal a more serious underlying circulatory issue.
Why the Difference Matters
At a glance, venous and arterial ulcers may seem similar. But treating them the same way can lead to serious complications.
For example, compression therapy is often a go-to treatment for venous ulcers. It improves blood flow by gently squeezing the leg to help move fluid and reduce swelling. However, applying compression to an arterial ulcer can actually be dangerous—it may further restrict already poor blood flow, increasing the risk of tissue death or even amputation.
That’s why an accurate diagnosis is critical.
Diagnosing the Right Type of Ulcer
At American Surgeons Group, we use a combination of visual assessment, patient history, and diagnostic tools to determine whether a leg ulcer is venous or arterial in origin. One key test is the Ankle-Brachial Index (ABI), which compares blood pressure in the ankle and arm to assess arterial flow. This helps guide a safe and effective treatment plan.
How We Treat Venous and Arterial Ulcers in South Chicago
For venous ulcers, treatment may include:
Compression therapy
Wound debridement (removing dead or damaged tissue)
Topical treatments and dressings
Elevation of the legs
Lifestyle changes like increased movement and weight management
For arterial ulcers, treatment focuses on:
Restoring blood flow, often through vascular surgery or procedures like angioplasty
Protecting the wound from infection
Pain management
Smoking cessation and management of underlying conditions like diabetes or high cholesterol
Prevention Is Key
Both types of ulcers are more common in older adults and people with chronic conditions like diabetes, high blood pressure, or a history of heart disease. Taking steps to manage these conditions—such as regular exercise, healthy eating, and quitting smoking—can reduce your risk of developing either kind of ulcer.
Trust American Surgeons Group for Expert Wound Care
Chronic leg wounds are more than just a nuisance—they’re a warning sign that something deeper is going on. At American Surgeons Group in South Chicago, we take a comprehensive approach to wound care, combining state-of-the-art diagnostics with compassionate, personalized treatment plans.
If you or a loved one has a non-healing wound, don’t wait. The sooner we identify whether it’s a venous or arterial ulcer, the better your chances for full recovery.
