Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Differing Types of Leg Ulcer’s Etiologies
  • Rheumatoid ulcers are described as deep, well demarcated and punched-out in appearance.
  • Persons with rheumatoid arthritis and other auto-immune and inflammatory conditions may develop vasculitis, which causes occlusion of small vessels leading to tissue ischemia. Ulcers resulting from vasculitis tend to have a purplish hue around the edges.
  • Diabetic ulcers are usually found on the foot, often over bony prominences such as the bunion area or under the metatarsal heads and usually have a sloughy or necrotic appearance. An ulcer in a diabetic client may have neuropathic, arterial and/or venous components. It is essential to identify underlying etiology. The Doppler measurement of the ABPI may be unreliable in the diabetic client if calcification prevents compression of the artery. Therefore, vascular assessment is required.
  • Malignancy is a rare cause of ulceration, and more rarely, a consequence of chronic ulceration. Ulcers with atypical site and appearance such as rolled edges, or non-healing ulcers with a raised ulcer bed should be referred for biopsy.