Arterial ulcers and venous ulcers are chronic wounds with different causes and appearances. Arterial ulcers occur due to arterial disease. Venous ulcers develop as a consequence of chronic venous insufficiency.

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Arterial ulcers typically present as deep, “punched-out” wounds with well-defined edges and can be painful.

Venous ulcers appear as shallow, irregularly shaped wounds with uneven edges.

This article discusses the similarities and differences in arterial versus venous ulcers as well as ways to tell the difference, treatment methods, and more.

Both arterial ulcers and venous ulcers are types of skin ulcers.

As their name suggests, arterial ulcers occur when arteries are unable to deliver enough oxygen-rich blood to tissue. Without the steady flow of oxygen and other nutrients, the tissue dies, and an arterial ulcer forms.

While they can develop anywhere on the body, arterial ulcers typically occur on the lower legs or ankles, feet, and toes.

Ultimately, poor circulation causes arterial ulcers. Some common health conditions that contribute to reduced blood flow include:

Other factors may include age, trauma, and smoking.

Venous ulcers occur due to problems with the veins in the legs — typically venous insufficiency — where the valves in a person’s veins do not work properly. The veins are unable to sufficiently send blood back to the person’s heart, so it pools in their legs and feet.

Chronic venous insufficiency can lead to venous hypertension, or high blood pressure in the legs, which also can cause venous ulcers.

Venous ulcers are more common than arterial ulcers, accounting for 70–90% of lower extremity ulcers.

Ultimately, a person’s healthcare professional will diagnose the ulcer. However, a person may notice the following differences between the two in relation to pain level, location, and visual characteristics.

Arterial ulcers tend to be more painful in the affected area, while venous ulcers may cause a dull ache throughout the entire leg.

Also, arterial ulcers are small and deep with a “punched-out” look, while venous ulcers are large and shallow with irregular borders.

The following are characteristics of arterial and venous ulcers.

Arterial ulcers

Arterial ulcers occur on the ankles, heels, toes, or other areas of the feet.

Arterial ulcers:

  • are small, deep, round wounds that look like hole punches
  • have well-defined borders
  • vary in color from pale or gray to red, brown, and black
  • are painful

The surrounding skin may be hairless and feel tight or itchy. Additionally, poor blood circulation can cause the affected area to feel cool or cold to the touch.

Venous ulcers

Venous ulcers also occur on the lower leg, but they typically develop somewhere between the knee and the ankle.

Venous ulcers:

  • are large, shallow wounds with an inflamed base
  • have irregular and uneven borders
  • may radiate a dull ache throughout the leg
  • may appear moist or weepy

The surrounding skin may be shiny, tight, discolored, and warm or hot to the touch.

Sometimes, yellow tissue covers a venous ulcer, and if the ulcer becomes infected, it may develop a foul odor and drain pus.

Is one more painful than the other?

Typically, arterial ulcers are the more painful of the two types of skin ulcers.

Many people with venous ulcers experience pain, but it is usually a mild-to-moderate ache that radiates through the leg.

Whether treating arterial ulcers or venous ulcers, physicians will focus on:

  • increasing blood circulation to the affected area
  • clearing up any existing infection, typically with antibiotics
  • keeping the wound clean and properly bandaged

Proper diagnosis and treatment for each type of ulcer are essential to address the underlying cause of the circulatory issues and promote effective wound healing.

Treating arterial ulcers

Restoring blood flow to the affected area is critical to treating arterial ulcers — without a steady supply of oxygen-rich blood, the ulcers cannot heal.

Antibiotics can clear up or prevent infection; however, they do not heal the ulcer itself.

There are a number of ways to improve circulation, including:

Additionally, compression therapy is a common way to improve blood flow. However, research suggests compression therapy is not suitable for people with critical ischemia, or inadequate blood supply.

There are also surgical options, such as angioplasty, to improve circulation.

A person’s doctor can recommend the best way to improve circulation according to their individual needs, as well as advise them on how to keep the ulcer clean and bandaged in the meantime.

If they are unable to restore blood flow, or if the arterial ulcer becomes critically infected, the doctor may recommend amputation.

Treating venous ulcers

Similar to treatment for arterial ulcers, treatment for venous ulcers focuses on improving blood flow, treating and preventing infection, and treating the underlying cause.

Typically, venous ulcers heal more quickly than arterial ulcers. The United Kingdom’s National Health Service (NHS) notes that most heal within 3–4 months.

During that time, a person’s doctor will instruct them on properly cleaning and bandaging the wound. Additionally, they may recommend the following:

  • using compression therapy to improve blood flow and reduce swelling
  • taking an over-the-counter medication or prescribing medication for pain relief
  • keeping the leg elevated to help reduce swelling

Their doctor can check on the healing process during follow-up appointments.

Arterial ulcers are deep, painful wounds that occur when there is inadequate blood supply, resulting in tissue damage and slow healing.

Venous ulcers are larger, shallower sores that develop as a consequence of impaired circulation in the veins.

Treatment approaches for each differ somewhat, though they all focus on improving blood circulation, healing and preventing infection, and treating the underlying health condition.