Cause of lower limb ulcer :- venous/ arterial or neuropathic?
Hello! Q. Today, in our OPD ,a 45 year old diabetic Male, farmer by profession presented with an ulcer on left lateral malleolus . He had a history of oedema in lower limb a/w itching 2years back. 6 months back he got an ulcer on left lateral malleolus which is not healing since then. On examination:- Pigmentation of skin ,eczema lipodermatosclerosis ,atrophied Blanche are present and dilated veins on the medial aspect of left lower limb. My question is how to differentiate whether the ulcer has arised due to neuropathy ,Venous stasis or obliteration of artery . Why this doubt has arised? Because Venous ulcer are commonly found at the lower third of the leg usually on the medial side and even on the foot. Ans. (I) To rule out neuropathy , 1.Ask whether he feel the ground and peeble while walking barefoot 2.Test for the pain sensation ,whether it is intact or not. (II) Venous ulcer have characterstic finding. History is utmost important. They are shallow and flat. The e