Info

Pulses

Temperature Edema

Skin Changes

Ulceration Gangrene

(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.

Normal

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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