Mark Finkelstein DPM
Board-Certified, American Board of Podiatric Surgery
Board-Certified, American Board of Podiatric Medicine
Comprehensive Assessment
 Complete History and Physical- claudication?, Rest pain,
night pain? History of smoking?
 Lower extremity examination-always check between the
toes
 Wound assessment-infection,size,depth,exudate,base
 Vascular assessment-Pulses, Non Invasive testing,
Angiogram
Arterial Ulcer Characteristics
 Located on bony prominences of the legs and feet
 “Punched-out” appearance with well-defined borders
 Shiny atrophic skin, no hair growth
 Little/no edema or wound exudate
 Yellow slough or black eschar in the wound bed with
little granulation tissue
 Feet are cool to touch and pedal pulses are often not
palpable
Arterial Ulcer Characteristics
Assessment of Pedal Pulses
Vascular Assessment-Clinical
Elevation Pallor
Dependent Rubor
Treatment of Arterial Disease
•Refer for vascular evaluation
•Cardiovascular disease should be
identified and managed
•Recommend tobacco cessation
•Increase regular exercise to improve
symptoms of claudication
Treating The Arterial Wound
•Do not debride dry, stable eschar until
perfusion status is determined
•For ulcers with insufficient flow, maintain dry,
stable eschar
Treating the Arterial Wound
•For ulcers with sufficient arterial flow,
implement moist wound healing, enzymatic
debridement and proper offloading
•Treat infection promptly -consider Infectious
Disease Consult
Vascular assessment
•Noninvasive vascular testing
Vascular Assessment
• Evaluate vascular status with angiogram
Vascular treatment
•Endovascular- Techniques
Vascular treatment
•Surgical Bypass-
Evaluate risk factors for
atherosclerosis
•Smoking, diabetes, hypertension,
hypercholesterolemia, advanced age, obesity,
family history
•Review of labs to identify risk markers –
elevated total cholesterol, triglycerides and
reduced high density cholesterol
Multidisciplinary approach
1. Medical therapy- beta blockers, statins, ACE
inhibitors and antiplatelet therapy
2. Teach chronic disease management
3. Optimize nutrition
4. Tobacco cessation
programs
5. Evaluate functional, cognitive and emotional state of
the patient
Multidisciplinary approach
•Increase regular exercise and physical activity to improve
symptoms of claudication
•Proper pain control of ulcerations
Arterial ulcers -Summary
Requires a multidisciplinary approach for proper management
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Wound Care Specialist-Podiatrist, Wound Nurse
Vascular /Interventional Radiologist
Vascular surgeon
Primary Care Physician
Dietitian
Mental Health Provider
Orthotist
Physical Therapist
Pain Management Specialist
Arterial ulcerations
QUESTIONS
THANK YOU