(Sources of photos: Arterial Insufficiency—Kappert A, Winsor T: Diagnosis of Peripheral Vascular Disease. Philadelphia, FA Davis, 1972; Venous Insufficiency—Marks R: Skin Disease in Old Age. Philadelphia, JB Lippincott, 1987)
Intermittent claudication, progressing to pain at rest Decreased or absent
Pale, especially on elevation; dusky red on dependency Cool
Absent or mild; may develop as the patient tries to relieve rest pain by lowering the leg
Trophic changes: thin, shiny, atrophic skin; loss of hair over the foot and toes; nails thickened and ridged
If present, involves toes or points of trauma on feet May develop
None to an aching pain on dependency
Normal, though may be difficult to feel through edema
Normal, or cyanotic on dependency. Petechiae and then brown pigmentation appear with chronicity.
Present, often marked
Often brown pigmentation around the ankle, stasis dermatitis, and possible thickening of the skin and narrowing of the leg as scarring develops
If present, develops at sides of ankle, especially medially Does not develop
TABLE 14-3 ■ Common Ulcers of the Feet and Ankles
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