Last updated on October 30, 2026
A leg ulcer is a wound on the lower leg or foot that hasn’t healed within about 2 weeks. Most are caused by a problem with circulation, either in the veins (a venous ulcer) or in the arteries (an arterial ulcer). Some people have both, which is called a mixed ulcer.
Telling them apart matters, because the right treatment for one can be harmful for the other. Firm compression, which is the main treatment for a venous ulcer, can be dangerous if the arteries are narrowed. This guide explains how the two types differ, how doctors check which one you have, and what helps each one heal.
What is a venous leg ulcer?
Venous ulcers are the most common type of leg ulcer. They happen when the valves inside the leg veins stop working, so blood flows backwards and pools in the lower leg. The pressure in the veins rises, fluid leaks into the surrounding tissue, and over time the skin around the ankle becomes stained, fragile and slow to heal. A small knock or scratch can then turn into an ulcer that won’t close.
Most venous ulcers are linked to faulty surface veins, such as the great saphenous vein, which can be treated. Some follow a previous deep vein thrombosis (DVT). You can read more on our venous leg ulcer page.
What is an arterial leg ulcer?
Arterial ulcers are caused by a poor blood supply to the leg and foot. The arteries become narrowed or blocked, most often by a build-up of fatty plaque (peripheral arterial disease), so the skin doesn’t get enough oxygen to heal even a small wound.
The main risk factors are smoking, diabetes, high blood pressure, high cholesterol, older age, and heart or kidney disease. People with an arterial problem may also notice cramping pain in the calf when walking that eases with rest.
Venous vs arterial ulcers: the key differences
Every ulcer is different and only an examination can tell you for certain, but these features are typical.
| Venous ulcer | Arterial ulcer | |
|---|---|---|
| Where it appears | Lower leg, usually just above the inner ankle | Feet, toes, heels, or over the shin and pressure points |
| How it looks | Shallow, irregular in shape, often moist with a red or yellow base | Deep and “punched out”, with neat edges and a pale or dark base |
| Pain | Aching or heaviness, eased by raising the leg | Often very painful, worse at night or when the leg is raised, eased by hanging it down |
| Skin around it | Brown staining, itchy or dry skin (venous eczema), hard tight skin, varicose veins | Thin, shiny, pale skin, little hair, thickened toenails |
| Foot temperature and pulses | Foot usually warm, pulses usually present | Foot often cool, pulses weak or hard to feel |
| Swelling | Ankle swelling is common | Swelling is less common |
Mixed ulcers
Some ulcers have both a venous and an arterial cause. This is more common in older people and in people with diabetes. Mixed ulcers need careful assessment, because compression may still help but usually at a lower, carefully chosen pressure, and only once the blood supply has been checked.
How doctors tell which type you have
Your doctor will look at the ulcer and the skin around it, feel for the pulses in your feet and ask about your symptoms and health. The usual tests are:
- Ankle-brachial pressure index (ABPI): a simple test comparing the blood pressure at your ankle and your arm. It is checked before compression is started.
- Venous duplex ultrasound: shows which leg veins have faulty valves and whether the deep veins are affected. See venous duplex ultrasound.
- Arterial ultrasound: shows whether the leg arteries are narrowed or blocked, and where.
Why the difference changes treatment
Treating a venous ulcer
Venous ulcers are treated with good wound care and compression bandaging or stockings, which push against the high pressure in the veins and help the wound close. Raising your legs when resting and walking regularly also help.
Dressings and compression don’t fix the faulty veins underneath, though. A large UK trial (EVRA, published in 2018) found that treating the faulty surface veins early, while the ulcer was still open, helped ulcers heal faster than waiting until after they had healed. Treating the veins, usually with radiofrequency ablation or foam sclerotherapy, also lowers the chance of the ulcer coming back.
Treating an arterial ulcer
An arterial ulcer won’t heal until the blood supply improves. That usually means a specialist assessment of the arteries and, if needed, a procedure to open or bypass the narrowed artery, such as angioplasty or surgery. Firm compression is avoided. Stopping smoking and managing diabetes, blood pressure and cholesterol are an important part of treatment.
Helping a leg ulcer heal
- See your GP if a wound on your leg hasn’t healed after 2 weeks, so the cause can be found early.
- Keep the ulcer clean and covered with the dressing your nurse or doctor recommends, and avoid putting creams or ointments on it without advice.
- Only use compression bandages or stockings once your blood supply has been checked.
- For a venous ulcer, raise your legs above the level of your heart when resting, and keep active with regular walking.
- If you smoke, stopping is one of the most helpful things you can do for healing.
- Keep diabetes and blood pressure well controlled.
When to get help urgently
See your GP the same day if the skin around the ulcer becomes hot, red and spreading, you have a fever, or the pain is getting quickly worse, as these can be signs of infection.
Go to an emergency department or call 000 if your foot or leg suddenly becomes cold, pale or blue, or very painful, as this can mean the blood supply has been cut off.
Getting help for a venous leg ulcer
At Vein Doctors Sydney, Dr Ryan McConnell assesses leg ulcers in Manly and St Leonards. Your first visit includes a vein ultrasound and an arterial ultrasound to check the blood supply, and wound care and compression bandaging are done in our rooms, so your wound care and vein treatment are managed together.
Ask your GP for a referral marked “venous ulcer” and we’ll see you within 2 weeks. Find out more about venous leg ulcer treatment or book a consultation.
Frequently Asked Questions
Can a leg ulcer be both venous and arterial?
Yes. A mixed ulcer has both a venous and an arterial cause. It is more common in older people and people with diabetes, and needs careful assessment before any compression is used.
Which type of ulcer is more painful?
Arterial ulcers tend to be more painful, especially at night or when the leg is raised. Venous ulcers more often ache or feel heavy, and usually feel better when the leg is raised.
Should I wear compression stockings for a leg ulcer?
Compression is the main treatment for venous ulcers, but it should only be started after your blood supply has been checked, usually with an ankle-brachial pressure index or an arterial ultrasound. Compression can be harmful if the arteries are narrowed.
How long does a venous leg ulcer take to heal?
It varies from weeks to months, depending on the size of the ulcer, how long it has been there and your general health. Compression and treating the faulty veins help it heal faster.
Can a venous ulcer come back?
Yes, venous ulcers can come back if the vein problem underneath isn’t treated. Treating the faulty veins and wearing compression stockings afterwards lowers that risk.
This information is not intended to be used for diagnosis or treatment. It is aimed at presenting a perspective only and is not a substitute for a prescription. Anyone experiencing a medical condition should consult their doctor.
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