Table of Contents
A foot ulcer is a break in skin continuity on or around the feet that may be of arterial, venous or neuropathic aetiology.
Suggested approach to foot ulcer osce station
Describing lesions
- Arterial ulcer
- ‘There is a well-demarcated ulcer on the tip of the right great toe.’
- ‘It has a diameter of 1cm and a punched-out appearance.’
- ‘The ulcer has a necrotic base.’
- ‘The surrounding skin is cool and pale, and the dorsalis pedis and posterior tibial pulses are very weak.’
- ‘This lesion is characteristic of an arterial ulcer.’
- Venous ulcer
- ‘There is a large superficial ulcer on the medial gaiter region of the right leg.’
- ‘This has a diameter of approximately 14cm and has an irregular border.’
- ‘The ulcer has an exudative, granulating base.’
- ‘There is associated venous eczema and lipodermatosclerosis.’
- ‘This lesion is characteristic of a venous ulcer.’
- Neuropathic ulcer
- ‘There is a well-demarcated ulcer on the plantar aspect of the first metatarsophalangeal joint.’
- ‘It has a diameter of 1cm and a punched-out appearance.’
- ‘The ulcer has a granulating base.’
- ‘The surrounding skin is hyperkeratotic and there is reduced sensation peripherally.’
- ‘This lesion is characteristic of a neuropathic ulcer.’
Other aspects of examination
- Surrounding skin (including temperature)
- Peripheral pulses and capillary refill
- Peripheral sensation
If you are required to ask the patient questions
- Associated pain and when this is worse
- Loss of sensation
- History of diabetes, vascular disease, varicose veins, DVT
Types of foot ulcer
Possible investigation to determine cause
- Fasting glucose: to exclude diabetes
- Ankle brachial pressure index: <0.9 = peripheral vascular disease
- Duplex ultrasound: to look for peripheral vascular disease or venous incompetence
- X-ray: to exclude osteomyelitis
Swabs for MC&S: if signs of infection
