From the Research
Ischemic ulcers typically occur on the lateral aspects of the feet, toes, heels, and areas over bony prominences, while diabetic ulcers predominantly occur on weight-bearing areas such as the plantar surface of the foot. The location of ulcers on the lower extremities is crucial in determining the underlying cause and guiding treatment. Ischemic ulcers are often associated with poor blood supply and can be painful, with well-defined edges and a pale or necrotic appearance 1. In contrast, diabetic ulcers are typically painless due to peripheral neuropathy and have a punched-out appearance with a rim of callus surrounding them 2. A study published in 2020 found that cilostazol, a medication used to treat intermittent claudication, can improve wound healing in patients with diabetic foot ulcers and peripheral artery disease 2. Another study published in 2018 found that cilostazol use was associated with improved ulcer healing and amputation-free survival in patients with critical limb ischemia 3. Proper assessment of ulcer location, along with evaluation of vascular status and neurological function, is essential for determining appropriate treatment strategies, which may include offloading, wound care, infection management, and vascular intervention when necessary. Key factors to consider when evaluating ulcer location include:
- The presence of peripheral arterial disease or neuropathy
- The size and depth of the ulcer
- The presence of exposed bone, tendon, or joint
- The presence of gangrene
- The patient's overall health status and medical history By considering these factors and using medications such as cilostazol, healthcare providers can develop effective treatment plans to promote wound healing and prevent amputations in patients with ischemic and diabetic ulcers 4, 5.