A common warning sign of Peripheral Artery Disease (PAD) is an ulcer or a wound that is slow to heal on the feet or legs. When sores or wounds do not get enough blood it can affect your body’s ability to heal the wound and increases the risk of infection. This is why patients with poor circulation due to PAD often need special care in order to heal a wound.
Wounds are described as either acute or chronic. A chronic wound is a wound that has failed to heal in 4-6 weeks and does not move through the normal stages of healing. When wounds fail to heal, they can result in pain, infection, and can lead to amputation. In addition, chronic wounds can lead to loss of workdays and lost income.5
Wounds can have many different causes and multiple influences. Therefore, when choosing the right plan of care it is important that all factors that contribute to wound healing are taken care of. In other words, do not just address the wound itself, but underlying infection, nutrition, and specific patient lifestyle factors which should be considered to optimize wound healing.
PAD & Chronic Wounds
Patients with underlying PAD are at increased risk of developing nonhealing wounds and ulcers and have a higher rate of amputation. Therefore, it is important for people that have PAD to seek out wound care. Here are some common wounds that occur in patients with Peripheral Artery Disease.
Arterial ulcers are caused by blockages in the arteries that are responsible for delivering oxygenated blood to the lower extremities. This leads to tissue damage and a state of ischemia, as the tissue lacks the necessary oxygen for healing. These wounds or ulcers typically have a “punched out” appearance and are well-circumscribed with pale pink, gray, or yellow appearance. The ulcers may be located between or on the tips of the toes or in the lower leg and are typically full-thickness.3
Diabetic (Neuropathic) Foot Ulcers
These foot ulcers are the result of the loss of peripheral sensation, often seen in patients with diabetes. This loss of sensation causes extended microtrauma, leading to the breakdown of overlying tissue, and the eventual formation of an ulcer.4 The ulcer may not be painful due to lack of sensation, and often occurs at pressure points, including the plantar aspect of the foot. These ulcers tend to be round, with calloused edges and a partial- or full-thickness, and with a pale or pink appearance.
Dr. Scott Brannan talks about how diabetes contributes to peripheral artery disease and neuropathy.
Causes and Risk Factors
In addition to PAD and vascular insufficiency, common contributing causes of chronic wounds include diabetes mellitus, renal failure, trauma, foot deformity, callus formation, limited joint mobility, and smoking history.
Unique risk factors for neuropathic ulcers include primary neurological conditions, alcohol-related neuropathy, spinal abnormalities, trauma, or surgery. Treatment includes managing foot care, debriding the wound, and reducing the pressure on the affected area. Amputation may become necessary in severe cases. At-risk patients should take precautions to control their diabetes, inspect their feet daily, and ensure they have proper footwear.3
Wound Care & PAD Treatment
Patients with underlying PAD and a chronic wound can help prevent serious complications by seeking treatment in the early stages of the wound, to help identify and treat both the PAD as well as other factors which may be impacting wound healing. Exercising, eating properly, avoiding tobacco, and managing any underlying conditions — such as diabetes or high blood pressure, or cholesterol — can help prevent PAD from developing or progressing.
Treatment for arterial ulcers focuses on the restoration of adequate circulation, usually via minimally invasive, or endovascular techniques or less often with surgical revascularization. All patients with PAD and ulceration are advised to control medical factors including diabetes, hypertension, and cholesterol, optimize nutrition, and stop smoking to promote a healthy wound environment and expedite healing after revascularization. A comprehensive approach to wound healing with PAD can help prevent amputation and save lives.
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- Myers, B (2008). Wound Management: Principles and Practice. (2nd Edition). Pearson Prentice Hall. Upper Saddle River, New Jersey.
- Worley, C (2004). Why won’t this wound heal? Factors affecting wound repair. Dermatology Nursing. Downloaded from the web January 18,
- Cleveland Clinic. Lower Extremity (Leg and Foot) Ulcers. Cleveland Clinic. http://my.clevelandclinic.org/heart/disorders/vascular/legfootulcer.aspx. Published August 17, 2017. Accessed March 28, 2019
- Salcido R. Pressure Ulcers and Wound Care. Medscape Reference. http://emedicine.medscape.com/article/319284-overview#aw2aab6b2. Updated June 11, 2018. Accessed March 28, 2019.
- 2011 Spear, M. (2013). Acute or chronic? What’s the difference? Plastic Surgical Nursing, 33(2); pg. 98-100. Downloaded February 10, 2013. http://www.nursingcenter.com/lnc/Static-Pages/Acute-or-Chronic-What-s-th…