# Arterial ulcer > An arterial ulcer is a foot or lower leg wound caused by poor blood supply. It needs a circulation check and care to restore blood flow. Guide in [Wounds and ulcers](https://footanklelowerlimb.com.au/learn/topics/wounds-and-ulcers), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/arterial-ulcer Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 1 November 2026. Next review by 1 November 2027. - **It's a wound caused by poor blood supply,** usually on the foot or around the ankle. - **The cause is the circulation,** so caring for the wound surface alone isn't the fix. - **Compression only if a health professional confirms it's safe,** because it can harm when blood supply is reduced. - **Stopping smoking and staying active help.** ## What is an arterial ulcer? An arterial ulcer is a wound on the foot or lower leg caused by a problem with the blood supply to the leg [1]. Narrowed or blocked leg arteries leave the skin starved of oxygen and nutrients [2]. It's part of peripheral arterial disease (PAD) [1]. Ulcers from artery disease or diabetes most often occur on the foot rather than the leg [3]. A painful foot or ankle wound that is slow to heal may be a circulation problem, not just a skin problem. ## What causes an arterial ulcer, and who gets one? An arterial ulcer arises when fatty deposits (atherosclerosis) collect inside the leg arteries, narrowing them and limiting the blood that reaches the leg [1]. Smoking and diabetes are the main risk factors for PAD [4]. High blood pressure, rheumatoid arthritis and heart disease are also linked to narrowed arteries [5]. Roughly half of people who have both diabetes and a foot ulcer also have PAD, so a foot wound in someone with diabetes warrants closer attention [6]. ## What does an arterial ulcer feel like, and how is it diagnosed? An arterial ulcer is often painful, usually on a toe, heel, bony area, side of the foot or lower leg, with little or no discharge [5][7]. The foot may feel cold and look pale or bluish and shiny [5]. Pain is often worse at night and eases when the leg hangs down [5]. Diagnosis uses circulation tests such as the ankle-brachial index (ABI), not feeling for pulses [8]. With diabetes, a normal ABI doesn't rule out PAD, so toe pressure tests may be added [8][9]. Symptoms suggesting PAD call for an ABI [9]. A wound not healing after 2 weeks is another reason to suspect poor blood supply [10]. ## What helps an arterial ulcer heal? A suspected arterial ulcer needs assessment and care from a healthcare professional and referral to a vascular team [1][2][7][11]. A suspected arterial ulcer points to poor blood supply to the leg [1][2]. The main treatment is restoring blood flow (revascularisation) [1][9][12]. That may be balloon angioplasty to open a narrowed or blocked artery, or bypass surgery when the blockage is too large for a balloon [1]. It's the cornerstone of preventing limb loss when blood supply is severely reduced [12]. Which approach suits whom isn't clear yet, so decisions need an experienced vascular team [12][13]. Medicines prescribed by a doctor, such as cholesterol, blood-thinning and blood pressure treatments, help manage cardiovascular risk factors in PAD [1][12][13]. On their own they do little for the limb when blood flow can't be restored [12]. Don't use compression bandages unless a healthcare professional has confirmed that compression is safe [2][14][15]. Arterial and venous ulcers are treated differently, and compression isn't safe when the blood supply is reduced [2][14][15]. A repeat vascular review, rather than only changing dressings, is worth discussing with the team. Talk with the team about your goals, pain and quality of life. ## What is the outlook, and how can I stop it coming back? Outlook depends largely on the circulation. Arterial ulcers are often a sign of advanced PAD, which is linked with a higher risk of serious illness [16]. If you have diabetes, PAD makes a foot ulcer more likely to fail to heal or lead to a major amputation [17]. Stopping smoking is the single most important change you can make [1]. Exercise also eases PAD symptoms [1]; structured exercise, supervised or community-based, is a core part of PAD care [9], such as a structured or home-based walking program. Agree it with your treating team. Practical help to stop smoking, such as referral to a quit-smoking service, is offered. If you have diabetes, include foot care and podiatry in your self-care plan [11]. Even after the wound heals, the artery disease remains, so keep having your circulation checked. ## What can make it serious? - Your foot ulcer is being treated but isn't getting better (ask about a review by the foot team). - You have diabetes or poor circulation and signs of infection in your foot, toe or nail, such as redness, warmth, swelling, pus, a bad smell or more pain. - You have diabetes, poor circulation or reduced feeling in your feet and notice a new wound, sore, blister or colour change on your foot, or a sore that isn't healing. - You have constant pain in your foot or toes that is worse at night or when your legs are raised, and eases when you hang your leg down (this can be a sign of poor circulation). - The skin on your toes or foot turns dark or black, or a wound turns black and smells bad. - You have a foot wound, ulcer or infection and also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine (possible sepsis). - Your leg or foot suddenly turns cold and pale, with pain or numbness, or you suddenly can't move it. ## Common questions ### Can an arterial ulcer heal on its own? It's unlikely to heal without attention to the blood supply. Arterial ulcers are prone to infection, but treating the infection alone usually won't heal the ulcer. The underlying circulation is the key factor, because the wound won't heal well without enough blood reaching the area. ### Why is my leg ulcer so painful at night? Pain from poor circulation is usually worse at night because raising your legs in bed reduces the blood supply to your feet. It usually eases when you lower your legs, such as hanging them down with your feet lower than your hips. ### What is an ankle-brachial index test? The ankle-brachial index (ABI) compares the blood pressure at your ankle with the pressure at your arm. It's the main first test for peripheral arterial disease. In people with diabetes or kidney disease, hardened artery walls can make the reading falsely high, so other tests may be added. ## Further reading - [Arterial ulcer on Clindice](https://clindice.com/arterial-ulcer) - [Foot and Toe Ulcers: Treatment, Prevention, Repair & Causes](https://my.clevelandclinic.org/health/symptoms/17169-foot-and-toe-ulcers), Cleveland Clinic - [Mix Aetiology leg ulcer - Leeds Community Healthcare](https://leedscommunityhealthcare.nhs.uk/our-services-a-z/tissue-viability-service/mix-aetiology-leg-ulcer-tvs/), NHS - [Peripheral Arterial Disease](https://medlineplus.gov/peripheralarterialdisease.html), MedlinePlus - [Peripheral Artery Disease and Lower Limb Bypass](https://www.uhb.nhs.uk/media/1ozpjehx/pi-vascular-surgery-peripheral-artery-disease-and-lower-limb-bypass.pdf), NHS - [Title of report goes here](https://oxfordhealth.nhs.uk/wp-content/uploads/sites/51/2025/01/NWCSP-Leg-Ulcer-Recommendations-v2-1.8.2023.pdf), NHS ## Sources 1. Arterial leg ulcer · Leeds Community Healthcare. https://leedscommunityhealthcare.nhs.uk/our-services-a-z/tissue-viability-service/arterial-leg-ulcer-tvs/ 2. Vascular - Arterial Leg Ulcers · Northern Care Alliance. https://www.northerncarealliance.nhs.uk/patient-information/patient-leaflets/vascular-arterial-leg-ulcers?q=%2Fpatient-information%2Fpatient-leaflets%2Fvascular-arterial-leg-ulcers 3. Venous leg ulcer · NHS. https://www.nhs.uk/conditions/leg-ulcer/ 4. Peripheral arterial disease · Cassar K · BMJ Clinical Evidence · 2007. https://pmc.ncbi.nlm.nih.gov/articles/PMC2907782/ 5. Display Patient Information Leaflets · University Hospitals Plymouth NHS Trust · 2024. https://www.plymouthhospitals.nhs.uk/display-pil/pil-chronic-leg-ulcers-7205/ 6. The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes mellitus and a foot ulcer · Fitridge R, Chuter V, Mills J et al. · Journal of Vascular Surgery · 2023. https://doi.org/10.1016/j.jvs.2023.07.020 7. Leg ulcers — foot ulcers · Healthdirect Australia. https://www.healthdirect.gov.au/conditions/skin-conditions/leg-ulcers 8. Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review · Chuter V, Schaper N, Mills J et al. · Diabetes/metabolism Research and Reviews · 2024. https://doi.org/10.1002/dmrr.3683 9. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines · Gornik HL, Aronow HD, Goodney PP et al. · Journal of the American College of Cardiology · 2024. https://doi.org/10.1016/j.jacc.2024.02.013 10. Foot Ulcer Pathways - Primary Care · NHS. https://www.dbth.nhs.uk/wp-content/uploads/2024/01/Foot-Ulcer-Pathway-Primary-Care-2024.pdf 11. Diabetes & Foot Problems · National Institute of Diabetes and Digestive and Kidney Diseases · 2026. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems 12. The Current State of Critical Limb Ischemia: A Systematic Review · Farber A, Eberhardt RT · JAMA Surgery · 2016. https://doi.org/10.1001/jamasurg.2016.2018 13. Canadian Cardiovascular Society 2022 Guidelines for Peripheral Arterial Disease · Abramson BL, Al-Omran M, Anand SS et al. · The Canadian Journal of Cardiology · 2022. https://doi.org/10.1016/j.cjca.2022.02.029 14. I have a leg ulcer. Why am I being referred? · dbth.nhs.uk. https://www.dbth.nhs.uk/wp-content/uploads/2025/02/I-have-a-leg-ulcer.-Why-am-I-being-referred-to-a-vascular-clinic_final-1.pdf 15. Title of report goes here · hct.nhs.uk. https://www.hct.nhs.uk/download/nwcsplegulcerrecommendationsfinalversion15072024pdf.pdf?doc=docm93jijm4n12312.pdf&ver=16431 16. Arterial Leg Ulcers in the Octogenarian · Fierro AL, Abeshouse M, Lagziel T et al. · Clinics in Geriatric Medicine · 2024. https://doi.org/10.1016/j.cger.2023.12.010 17. Performance of non-invasive bedside vascular testing in the prediction of wound healing or amputation among people with foot ulcers in diabetes: A systematic review · Chuter V, Schaper N, Hinchliffe R et al. · Diabetes/metabolism Research and Reviews · 2024. https://doi.org/10.1002/dmrr.3701 --- This is general information, not advice about your own situation. To discuss your issues, book with one of our podiatrists. In an emergency, call 000.