Medical history and physical examination
The ulcer itself is easy to recognize. Indispensable for the treatment, however, is the distinction according to the cause. This often results already by the findings.
Differences between venous and arterial leg ulcers
Long leg swelling and additional skin changes such as brownish spots (congestion due to red cell emigration and deposition of their degradation products) or lack of pigmentation (atrophy blanche), induration and hardening of the feet (corona phlebectatica) are typical for venous leg ulcers ). The ulcer is usually at the ankles, especially on the insides. Not infrequently it is wet and bacteria settle down. This creates a foul smell.
Arterial leg ulcers are more likely to show on the toes, heels and ball of the foot. The feet and legs are cool and pale, the ulcers often hurt.
In addition, the history of the disease can usually be traced to the cause - often long-standing venous diseases or varicose veins or thromboses are known; arterial ulcers are often associated with diabetes or hypertension, or people who smoke or have elevated blood lipid levels.
At the center of the diagnostic apparatus is a special ultrasound examination (Doppler sonography) of the vessels, with which both the veins and the arteries can be assessed. In cases of suspected thrombosis, a vein count (venography) can be performed; for arterial occlusions, one of the arteries (angiography).
If there is a suspicion of a change in the skin of another cause, a tissue sample (biopsy) is taken, if there is an infection, the pathogens are determined in order to initiate appropriate antibiotic therapy. A blood sample can reveal blood sugar, lipid metabolism and coagulation disorders. In addition, a whole range of special diagnostic procedures is available