A leg ulcer is an open sore that does not heal normally. While several conditions can cause chronic wounds, problems involving the veins and arteries are among the important causes of leg ulcers. Venous ulcers and arterial ulcers may both appear as wounds on the lower leg or foot, but they develop because of different circulation problems and may require very different approaches to treatment.

Knowing the difference can help people recognize warning signs and understand why proper diagnosis is important before beginning treatment.

What Is a Venous Ulcer?

A venous ulcer develops when blood does not move effectively through the veins of the leg. Veins are responsible for carrying blood back toward the heart. When the valves inside the veins do not work properly, blood can flow backward and pressure can build up in the veins.

Over time, this increased pressure can damage the surrounding skin and make it more vulnerable to injury. Even a relatively minor scratch or knock may eventually develop into an ulcer.

Venous ulcers most commonly develop on the lower leg, particularly around the inner ankle area. They may be associated with swelling, skin discoloration, itching, hardened skin, aching, or a heavy feeling in the legs.

What Is an Arterial Ulcer?

An arterial ulcer develops because the arteries are not delivering enough blood to the affected tissue. Arteries carry oxygen-rich blood from the heart to the legs and feet. When an artery becomes narrowed or blocked, the tissues may receive less oxygen and fewer nutrients.

Reduced arterial blood flow can interfere with the body's ability to maintain healthy skin and repair injuries. In more severe cases, tissue can break down and form an ulcer.

Arterial ulcers are often found on the feet, toes, heels, or other areas exposed to pressure. The affected foot or leg may feel cold, and the skin can appear pale, bluish, or shiny. Pain may also be significant, particularly when the leg is elevated or during periods of rest.

Venous vs. Arterial Ulcers: Main Differences

Although both conditions involve chronic wounds, there are several differences worth understanding.

Location

Venous ulcers commonly develop between the knee and ankle, particularly around the inner part of the lower leg and ankle.

Arterial ulcers are more likely to occur on the feet, toes, heels, or areas exposed to pressure.

However, location alone cannot confirm the cause of an ulcer. A healthcare professional needs to consider other symptoms and circulation findings as well.

Appearance of the Wound

Venous ulcers are often relatively shallow and may have irregular edges. The surrounding skin can become swollen, darkened, hardened, or irritated. The wound may also produce drainage.

Arterial ulcers can have a deeper appearance and may develop over areas with limited blood supply. The surrounding skin may appear pale or bluish and can become thin or shiny.

Because different types of ulcers can sometimes look similar, visual appearance should not be used as the only way to identify the cause.

Swelling

Swelling is commonly associated with venous disease. People with venous ulcers may experience swelling around the ankle and lower leg, particularly after prolonged standing or sitting.

Arterial ulcers are not typically characterized by the same type of swelling. Instead, reduced blood supply may cause coldness, changes in skin color, and other signs of poor arterial circulation.

Pain

Pain can occur with both types of ulcers, but the pattern may differ.

Venous ulcers can cause aching or discomfort, particularly when swelling is present. Some may be painful if infection or other complications develop.

Arterial ulcers can be particularly painful because the underlying problem involves inadequate blood supply. Some people experience more pain when the leg is elevated or while resting, and lowering the leg may provide temporary relief.

What Causes Venous Ulcers?

Several factors can increase the likelihood of developing venous ulcers. These include:

Varicose veins
Previous deep vein thrombosis
Limited mobility
Previous leg injury or surgery
Obesity
Increasing age
Problems with the valves inside the leg veins

A history of DVT can damage venous valves and contribute to abnormal blood flow. Limited walking can also reduce the effectiveness of the calf muscles, which normally help move blood upward through the legs.

What Causes Arterial Ulcers?

Arterial ulcers are associated with inadequate blood flow through the arteries. Peripheral arterial disease is one important cause.

Risk factors for arterial disease can include smoking, diabetes, high blood pressure, high cholesterol, and other conditions affecting cardiovascular health. When arteries become narrowed, less blood can reach the tissues of the legs and feet.

Because arterial disease can affect circulation throughout the body, a person with an arterial ulcer may need an evaluation of their overall vascular health.

Why Correct Diagnosis Matters

Correctly identifying the type of ulcer is important because treatment approaches can differ.

For example, compression therapy is commonly used for venous ulcers to help manage venous pressure and swelling. However, compression is not automatically appropriate for someone with significantly reduced arterial circulation. The NHS notes that ankle arterial pressure should be assessed before compression is used because compression may be unsafe when arterial pressures are low.

This is why people should not assume that a treatment used for one type of leg ulcer is appropriate for every chronic wound.

A vascular evaluation may be recommended when the cause of a wound is uncertain or when arterial disease is suspected. A Vascular Surgeon in Sugarland can assess circulation and help determine whether an underlying vascular problem may be contributing to a slow-healing wound.

How Doctors Evaluate a Leg Ulcer

Evaluation usually begins with a medical history and physical examination. A healthcare professional may ask about previous blood clots, varicose veins, diabetes, smoking, mobility, previous wounds, and other health conditions.

The location and appearance of the wound are also assessed. Pulses in the feet may be checked to evaluate arterial circulation.

Additional testing may be necessary. One commonly used assessment is a Doppler study, which can compare blood pressure at the ankle with blood pressure in the arm. This can help identify reduced arterial circulation.

Further vascular testing may be recommended depending on the findings.

When Should You Seek Medical Attention?

A wound that remains open for more than a couple of weeks should be evaluated rather than ignored. Venous leg ulcers are unlikely to heal without appropriate treatment, according to NHS guidance.

Seek medical attention if a wound becomes increasingly painful, swollen, red, warm, or begins producing unusual or foul-smelling drainage. Fever can also indicate infection.

People with diabetes, known circulation problems, or reduced sensation in their feet should be especially attentive to new wounds because complications may develop without obvious symptoms.

A specialized Wound Care Center in Sugarland may be appropriate when a wound is persistent or requires more detailed evaluation and management.

Can Venous and Arterial Problems Occur Together?

Yes. Some people can have both venous and arterial circulation problems. These are sometimes described as mixed ulcers.

This can make diagnosis and treatment more complicated because the healthcare team needs to consider both types of circulation problems before deciding on an appropriate treatment approach.

For this reason, a chronic leg wound should not automatically be assumed to be a venous ulcer simply because swelling or varicose veins are present.

Final Thoughts

Venous and arterial ulcers are both chronic wounds, but the underlying circulation problems are different. Venous ulcers are associated with problems returning blood through the veins and are commonly accompanied by swelling and skin changes around the lower leg. Arterial ulcers result from inadequate blood flow through the arteries and may be associated with coldness, skin color changes, and significant pain.

Because the treatment for one type may not be appropriate for another, determining the underlying cause is an important part of wound care. If a leg or foot wound is slow to heal, repeatedly opens, changes appearance, or develops signs of infection, professional evaluation can help identify the circulation problem and guide appropriate care.

Venous Ulcers vs. Arterial Ulcers: Key Differences to Know

Venous and arterial ulcers are chronic wounds caused by different circulation problems. Venous ulcers are commonly linked to poor blood flow through the veins,