This 69-year-old lady has had her ulcer of the left leg treated for many months by the district nurse using conventional bandaging. As it showed no signs of healing – indeed, if anything it seemed to be getting worse – she was referred to the vascular clinic at her local hospital. Here she gave a history of left calf pain on walking. This had been present for about a year and she was now only able to limp about 50 yards before having to stop and rest because of the pain. However, she put this down to the presence of the ulcer.
She had no problems with her right leg, gave no history of angina or of transient ischaemic attacks (TIAs), but did admit to being a ‘life-long’ cigarette smoker.
On examination, the ulcer had sloping edges and a necrotic base. The left foot was colder than the right, the toes were blue and Buerger’s test was positive. There were no varicose veins on either leg. All the pulses could be detected in the right leg but only the femoral pulse was present on the left.
What kind of ulcer is this and what’s the diagnosis ?
