Examining the local area

Introduction

When assessing an ulcer, examine the local area. There may be specific signs to aid diagnosis and management, including need for referral.

Leg

For patients with a leg ulcer, examine the leg for signs of vascular disease because it is the most common cause.

Up to 80% of leg ulcers are caused by chronic venous insufficiency, indicated by:

• oedema
• visible varicose veins or venous flares
• lipodermatosclerosis (hard skin and subcutaneous fibrotic tissue, ‘inverted champagne bottle leg’)
• haemosiderin (rust-coloured) staining of the skin.

Peripheral arterial disease is indicated by:

• reduced or absent lower-limb pulses
• skin atrophy
• pale, cold or tender foot
• thin hairless skin.

Look for deformity or reduced movement of the feet or other joints. The range of motion at the ankle joint influences the calf muscle’s function as a pump.

For information on management, see Overview of leg ulcers.

Foot

Check the foot for:

• loss of protective sensation (see Assessment for peripheral neuropathy)
• peripheral arterial disease (see Assessment for peripheral arterial disease)
• deformity
• dry atrophic skin, including over the heels—this can indicate autonomic neuropathy.

Probe foot ulcers (using a sterile metal probe) to see if there is communication with bone. Introduce the probe with slow gentle force, assessing all extents of the ulcer. If bone can be probed through the ulcer, this indicates a high risk of osteomyelitis, especially if the ulcer is infected.

Examine feet for callus formation—which indicates excessive local pressure—and examine heels for pressure injuries. Assess footwear (style, fit, condition, stability, fastening) and orthotic devices.

For information on management, see Wounds on a high-risk foot.

Sacrum, buttock (ischium) or hip (trochanteric area)

When examining a person with an ulcer on the sacrum, buttock or hip, note if the ulcer is over a bony prominence.

Using a sterile probe, assess the following:

• sinus tracts
• communication with deeper structures, including bone
• presence and extent of any cavity.

Assess support surfaces (eg mattress, chair cushion) and the techniques being used to position and reposition the person.

For information on management, see Pressure injuries.