Arterial ulcers are open wounds caused by reduced blood flow through the arteries, most often affecting the feet, toes, or heels. They develop when tissues do not receive enough oxygen and nutrients to maintain skin integrity, leading to breakdown and ulcer formation.
At Advanced Wound Therapy, we help patients understand not only what arterial ulcers are, but why they develop, how to recognize them early, and what steps can reduce the risk of serious complications.
Arterial ulcers—sometimes called ischemic ulcers—form when narrowed or blocked arteries limit blood flow to the lower extremities. Without adequate circulation, skin and underlying tissues become fragile and vulnerable to injury. Even minor trauma can progress into a chronic wound.
These ulcers differ from venous ulcers, which are caused by impaired blood return to the heart. Arterial ulcers result specifically from insufficient blood reaching the tissue, not from pooling or pressure within the veins.
They are most commonly associated with conditions such as peripheral artery disease (PAD) and atherosclerosis. According to the National Heart, Lung, and Blood Institute, PAD affects millions of Americans and is a leading contributor to arterial ulcer development.
Healthy tissue depends on a steady supply of oxygen, nutrients, and immune cells delivered through the bloodstream. When arterial circulation is compromised, several problems occur at once.
Red blood cells struggle to deliver oxygen needed for tissue maintenance. White blood cells cannot effectively respond to bacteria. Waste products accumulate instead of being carried away. Over time, this environment weakens the skin and prevents normal repair.
This is why arterial ulcers often:
Develop slowly
Become painful early
Take longer to improve without intervention
Carry a higher risk of infection and tissue damage
Several underlying conditions can contribute to arterial ulcer formation. The most common include:
Peripheral Artery Disease (PAD)
PAD occurs when plaque builds up in the arteries, narrowing the vessels and limiting blood flow to the legs and feet.
Atherosclerosis
This progressive hardening and narrowing of the arteries reduces circulation over time and is a major contributor to arterial ulcers.
Diabetes
Diabetes can damage blood vessels and worsen existing circulation problems, increasing the risk of foot and lower-extremity ulcers.
Smoking
Smoking constricts blood vessels and accelerates plaque formation, significantly increasing arterial disease risk.
Trauma or Pressure
In individuals with poor circulation, even minor injuries, pressure points, or friction can progress into non-healing wounds.
Early identification is critical. Arterial ulcers often have distinctive characteristics that set them apart from other wound types.
Common signs include:
Location: Toes, heels, outer ankle, or bony areas of the foot
Appearance: A round or “punched-out” wound with well-defined edges
Color: Pale, yellow, gray, brown, or black tissue with minimal bleeding
Pain: Often severe, especially when the leg is elevated
Temperature: Surrounding skin may feel cool to the touch
Skin changes: Shiny, thin, dry skin with little or no hair growth
Delayed healing: Little improvement over time without specialized care
Pain that improves when the leg is dangled downward and worsens when elevated is a classic arterial sign and should never be ignored.
Because both types appear on the lower extremities, they are often confused. However, their causes and characteristics differ significantly.
Arterial ulcers are caused by reduced blood flow to the tissue. They are typically painful, dry, and sharply defined.
Venous ulcers result from blood pooling away from the heart. They are often shallow, irregularly shaped, and associated with swelling, itching, and skin discoloration.
Correct identification is essential, as treatment approaches differ and inappropriate care can worsen the wound.
Preventing arterial ulcers starts with addressing circulation and protecting vulnerable skin.
Key prevention steps include:
Managing chronic conditions such as diabetes, PAD, and hypertension
Quitting smoking to improve vascular health
Engaging in appropriate physical activity to support circulation
Protecting feet from injury and pressure
Inspecting skin daily for early changes or breakdown
The CDC provides additional resources on smoking cessation and vascular health that can support long-term prevention efforts.
Treatment focuses on improving circulation, protecting tissue, and preventing complications. Management plans vary depending on severity and underlying health conditions.
Circulation Assessment and Intervention
Diagnostic testing may be used to evaluate blood flow and determine whether vascular intervention is necessary.
Wound Care Strategies
Care is carefully tailored to avoid further tissue stress. This may include selective debridement, pressure reduction, and specialized dressings designed to protect fragile tissue.
Advanced Support Options
In some cases, advanced wound care strategies may be appropriate to help maintain a healthier wound environment. These approaches do not heal the wound directly but support the body’s natural repair processes when circulation allows.
Without proper management, arterial ulcers can progress to infection, tissue necrosis, or limb-threatening complications. Delayed care increases the risk of hospitalization and surgical intervention.
Early evaluation allows providers to:
Identify circulation barriers
Adjust care before complications arise
Reduce pain and tissue loss
Improve long-term outcomes
You should seek evaluation if a wound:
Is painful and not improving
Appears pale, dark, or dry
Develops after minor trauma
Worsens when elevated
Shows signs of infection or tissue breakdown
Arterial ulcers require specialized assessment to ensure care decisions support—not compromise—circulation.
At Advanced Wound Therapy, our team focuses on identifying the underlying causes of arterial ulcers while supporting a wound environment that prioritizes tissue protection and safety. By evaluating each patient individually, we help guide care decisions that reduce risk and support long-term limb health.
If you or someone you care for is dealing with a wound that isn’t improving, early guidance can make a meaningful difference—reach out today to take the next step toward safer, more effective wound care.
Ready to take the first step? Consult a wound care specialist today to create a personalized plan for healing and prevention.
Author: Matt Carmichael, DO
