Chart — Med-Surg
Arterial vs Venous Ulcers Chart
Leg ulcers tell you their cause by where they sit and how they look. Get the type right and the care follows — including the single highest-stakes call: whether compression will heal the wound or worsen it.
Educational use only. Confirm arterial supply (ABI) before applying compression to any leg ulcer; mixed-etiology ulcers require provider-directed management. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Ulcer Comparison
| Feature | Arterial Ulcer | Venous Ulcer |
|---|---|---|
| Location | Toes, tips, lateral foot, pressure points (where perfusion is poorest) | Medial malleolus / gaiter area (inner ankle) |
| Shape & edges | Round, regular, 'punched-out,' well-demarcated | Irregular, shallow, poorly defined borders |
| Wound base | Pale, gray, or necrotic; minimal granulation (no blood = no healing) | Ruddy red granulation; often with yellow fibrinous slough |
| Drainage | Minimal — the tissue is dry and underperfused | Moderate to heavy — weepy from venous congestion |
| Pain | Severe; worse with elevation and at night; better dependent | Mild to moderate; better with elevation |
| Surrounding skin | Cool, pale, shiny, hairless; diminished pulses | Warm, brown hemosiderin staining, edema, stasis dermatitis |
| Cornerstone of care | Restore perfusion (revascularization); protect tissue; do NOT compress without arterial clearance | Compression therapy + elevation; manage exudate; treat the venous hypertension |
Exam Traps
- ✦Compression heals venous ulcers and can worsen arterial ones — verify arterial supply (ABI) before wrapping.
- ✦Punched-out, painful, on the toes/foot = arterial; irregular, weepy, on the medial ankle = venous.
- ✦Arterial ulcers are dry with minimal drainage; venous ulcers weep — drainage volume is a quick clue.
- ✦Arterial ulcer pain eases when the leg hangs down; venous ulcer pain eases with elevation.
- ✦A pale, non-granulating wound base signals poor perfusion (arterial) — it won't heal until blood flow is restored.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →