Narrowed arteries (atherosclerosis) are the most common cause of ischemic ulcers.

• Narrowed arteries prevent a healthy supply of blood from flowing to the legs. This means that the tissues in your legs do not get enough nutrients and oxygen.
• The lack of nutrients causes cells to die, damaging the tissue.
• Damaged tissue that does not get enough blood flow also tends to heal more slowly.

Conditions in which the skin becomes inflamed and fluid builds up in the legs can also cause ischemic ulcers.

People with poor blood flow often also have nerve damage or foot ulcers from diabetes. Nerve damage makes it harder to feel an area in the shoe that rubs and causes a sore. Once a sore forms, poor blood flow makes it harder for the sore to heal.

Symptoms of ischemic ulcers include:

• Wounds may appear on legs, ankles, toes, and between toes.
• Dark red, yellow, gray, or black sores.
• Raised edges around the wound (looks punched out).
• No bleeding.
• Deep wound through which tendons may show through.
• Wound may or may not be painful.
• Skin on the leg appears shiny, tight, dry, and hairless.
• Dangling the leg down off the side of a bed or chair causes the leg to turn red.
• When you raise the leg, it turns pale and cool to touch.
• Aching pain in the foot or leg, often at night. Pain may go away when the leg is dangled down.

Anyone with poor circulation is at risk for ischemic wounds. Other conditions that can cause ischemic wounds include:

• Diseases that cause blood vessel inflammation, such as lupus
• High blood pressure
• High cholesterol levels
• Chronic kidney disease
• Blockage of the lymph vessels, which causes fluid to build up in the legs
• Smoking

To treat an ischemic ulcer, blood flow to your legs needs to be restored. You may need to take medicine. In some cases, you may need surgery.

Your health care provider will show you how to care for your wound. The basic instructions are:

• Always keep the wound clean and bandaged to prevent infection.
• Your provider will tell you how often you need to change the dressing.
• Keep the dressing and the skin around it dry. Try not to get healthy tissue around the wound too wet. This can soften the healthy tissue, causing the wound to get bigger.
• Before applying a dressing, clean the wound thoroughly according to your provider's instructions.
• You may be able to change your own dressing, or family members may be able to help. A visiting nurse may also help you.

If you are at risk for ischemic ulcers, taking these steps may help prevent problems:

• Check your feet and legs every day. Check the tops and bottoms, ankles, heels, and between your toes. Look for changes in color and red or sore areas.
• Wear shoes that fit properly and do not rub or put pressure on your feet. Wear socks that fit. Socks that are too big can bunch up in your shoes and cause rubbing of the skin, which can lead to a sore.
• Try not to sit or stand too long in one position.
• Protect your feet from the cold.
• Do not walk barefoot. Protect your feet from injury.
• Do not wear compression stockings or wraps unless told to by your provider. These may restrict blood flow.
• Do not soak your feet in hot water.

Certain lifestyle changes can help prevent ischemic ulcers. If you have a wound, taking these steps can improve blood flow and aid healing.

• Quit smoking. Smoking can lead to narrowed arteries.
• If you have diabetes, keep your blood sugar level under control. This will help you heal faster.
• Exercise as much as you can. Staying active can help with blood flow.
• Eat healthy foods and get plenty of sleep at night.
• Lose weight if you are overweight.
• Manage your blood pressure and cholesterol levels.

Contact your provider if there are any signs of infection, such as:

• Redness, increased warmth, or swelling around the wound
• More drainage than before or drainage that is yellowish or cloudy
• Bleeding
• Odor
• Fever or chills
• Increased pain

Arterial ulcers - self-care; Arterial insufficiency ulcer self-care; Ischemic wounds - self-care; Peripheral artery disease - ulcer; Peripheral vascular disease - ulcer; PVD - ulcer; PAD - ulcer

Andrews KL, Derby KM, Jacobson TM, Sievers BA, Kiemele LJ. Prevention and management of chronic wounds. In: Cifu DX, ed. Braddom's Physical Medicine and Rehabilitation. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 24.

Bolognia JL, Schaffer JV, Cerroni L. Ulcers. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 5th ed. Philadelphia, PA: Elsevier; 2025:chap 105.

Boukovalas S, Aliano KA, Phillips LG, Norbury WB. Wound healing. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 6.

Updated by: Deepak Sudheendra, MD, MHCI, RPVI, FSIR, CEO & Medical Director, 360 Vascular Institute, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Columbus, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.