Share your insights

Help us by sharing what content you've recieved in your exams


Foot ulcers

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
    • β€˜There is a well-demarcated ulcer on the tip of the right great toe.’
    • β€˜It has a diameter of 1cm and a punched-out appearance.’
    • β€˜The ulcer has a necrotic base.’
    • β€˜The surrounding skin is cool and pale, and the dorsalis pedis and posterior tibial pulses are very weak.’
    • β€˜This lesion is characteristic of an arterial ulcer.’
  • Venous ulcer
    • β€˜There is a large superficial ulcer on the medial gaiter region of the right leg.’
    • β€˜This has a diameter of approximately 14cm and has an irregular border.’
    • β€˜The ulcer has an exudative, granulating base.’
    • β€˜There is associated venous eczema andΒ lipodermatosclerosis.’
    • β€˜This lesion is characteristic of a venous ulcer.’
  • Neuropathic ulcer
    • β€˜There is a well-demarcated ulcer on the plantar aspect of the first metatarsophalangeal joint.’
    • β€˜It has a diameter of 1cm and a punched-out appearance.’
    • β€˜The ulcer has a granulating base.’
    • β€˜The surrounding skin is hyperkeratotic and there is reduced sensation peripherally.’
    • β€˜This lesion is characteristic of a neuropathic ulcer.’

Other aspects of examination

  • Surrounding skin (including temperature)
  • Peripheral pulses and capillary refill
  • Peripheral sensationΒ 

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

Time for some viva questions

What are the 6 P’s of an acute ischaemic limb?

In what circumstance may ABPI be falsely elevated?

Oops! This section is restricted to members. Click here to signup!

How would you manage venous ulceration?

Try some related OSCE stations

  1. Diabetic foot exam
  2. Lower limb arterial exam
  3. Find more here

No comments yet πŸ˜‰

Leave a Reply