Ulcers in the lower limb are commonly grouped by their underlying cause into three major types: diabetic, arterial, and venous. While “diabetic foot” is widely discussed, a chronic non-healing wound on the foot or lower leg is not always caused by diabetes—correct identification is essential for effective treatment.

1) Diabetic Foot Ulcers

In diabetes, long-term high blood sugar can cause peripheral neuropathy (nerve damage) and sometimes impaired circulation. Loss of protective sensation and abnormal pressure distribution increase the risk of skin breakdown. Once an ulcer forms, it can become infected and, in severe cases, lead to tissue necrosis.

·        Common locations: Pressure points such as the sole, toe tips, and heel

·        Pain level: Often minimal or absent due to reduced sensation

·        Typical clues: Callus around the wound, pressure-related pattern, reduced sensation

2) Arterial (Ischaemic) Ulcers

Arterial ulcers occur in people with Peripheral Artery Disease (PAD). Reduced blood flow leads to tissue ischaemia (insufficient oxygen), making skin fragile and slow to heal.

·        Common locations: Toe tips, foot margins, heel, and distal lower leg

·        Pain level: Often severe, sometimes worse at night

·        Typical clues: Cold foot, weak/diminished pulses, delayed capillary refill, “punched-out” appearance

3) Venous Leg Ulcers

Venous ulcers are caused by chronic venous insufficiency, where damaged vein valves allow blood to pool in the lower legs (venous stasis). Over time, this leads to swelling, inflammation, skin changes, and ulceration.

·        Common locations: Usually the lower leg, especially the medial malleolus (gaiter area)

·        Appearance: Often shallow, broad, with irregular edges and heavier exudate

·        Typical clues: Leg swelling, skin discoloration, itchiness/eczema-like changes; pulses often present

Why this matters

Lower-limb ulcers should never be ignored. Identifying the root cause is the first step—because treatment is different (e.g., offloading for diabetic ulcers, vascular assessment for arterial ulcers, compression therapy for venous ulcers when appropriate). If you’re unsure, consult a wound specialist nurse for a professional assessment and care plan.