Venous | Arterial | Neuropathic | |
History | Prior deep venous thrombosis, stroke, miscarriages Obesity, multiple pregnancies Pain upon prolonged standing | Cigarette smoking Diabetes Dyslipidemia Intermittent claudication | Diabetes Other causes of peripheral neuropathy |
Location | Gaiter distribution Malleolar regions (medial > lateral) | Pressure sites Distal points (toes) | Pressure sites |
Pain | Mild to moderate | Severe | Painless |
Morphology | Irregular borders Shallow | Necrotic eschar Punched out | Punched out |
Surrounding skin | Pigmentation secondary to hemosiderin Lipodermatosclerosis | Shiny atrophic skin with hair loss | Thick callus surrounding ulcer |
Other physical examination findings | Varicosities Peripheral edema Stasis dermatitis | Weak/absent peripheral pulses Prolonged capillary refilling time (>3 to 4 seconds) Pallor on leg elevation (45° for 1 min) | Peripheral neuropathy with decreased sensation |
Relevant studies | Duplex ultrasonography | Ankle-brachial index Computed tomography angiography (CTA) Magnetic resonance angiography (MRA) |
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