HarvardCare at Home 
Wound Care
Not all leg wounds are the same — and treating them the same way can be dangerous. Arterial ulcers and venous ulcers are two of the most common types of chronic leg wounds, but they have completely different causes, appearances, locations, and treatments. Applying compression therapy to an arterial ulcer, for example, can cause serious harm. Knowing the difference matters.
This guide explains how to tell arterial and venous ulcers apart, what causes each, and how Medicare-covered skilled nursing wound care at home through HarvardCare at Home addresses both types throughout Los Angeles County.
The Fundamental Difference: Arteries vs. Veins
The core distinction between these two wound types comes down to circulation. Arterial ulcers are caused by inadequate blood flow to the tissues — the arteries that carry oxygenated blood to the legs are blocked or narrowed (a condition called peripheral artery disease or PAD), starving tissues of oxygen and nutrients until they break down. Venous ulcers are caused by inadequate blood return from the legs — the veins that carry blood back to the heart are damaged or incompetent, allowing blood to pool in the lower legs and creating pressure, inflammation, and eventually tissue breakdown.
Both types result in open wounds on the lower extremities, but because the underlying pathology is so different, effective treatment — and safe treatment — requires correctly identifying which type you’re dealing with.
Venous Ulcers: Causes, Appearance, and Location
Venous ulcers (also called venous stasis ulcers or venous leg ulcers) are the most common type of chronic leg wound, accounting for approximately 70–80% of all leg ulcers. They affect an estimated 500,000 to 600,000 Americans and are responsible for significant healthcare costs, disability, and reduced quality of life.
What Causes Venous Ulcers?
Venous ulcers develop when the one-way valves inside leg veins become damaged or incompetent, usually due to a history of deep vein thrombosis (DVT), varicose veins, obesity, prolonged standing, pregnancy, or previous leg injury. When these valves fail, blood pools in the lower legs (a condition called chronic venous insufficiency). This pooling creates high pressure in the small capillaries, allowing fluid, red blood cells, and proteins to leak into surrounding tissue. Over time, this leads to chronic inflammation, skin changes, and eventually wound formation. To learn more, read our existing guide on understanding venous ulcers: causes, symptoms, and treatment.
Where Venous Ulcers Appear
Venous ulcers almost always appear on the inner ankle or lower leg, typically in the area called the “gaiter zone” — from the ankle to just below the knee, on the medial (inner) aspect. This location corresponds to where venous pressure is highest when the valve system is failing.
What Venous Ulcers Look Like
Venous ulcers are typically shallow wounds with irregular, sloping edges. The wound base is usually red or pink with granulation tissue, though it may have areas of yellow slough (dead tissue). The skin around the wound — the periwound area — is characteristically discolored, showing a brownish-red or brownish-purple staining called hemosiderin deposition from the breakdown of leaked red blood cells. The surrounding skin is often thickened, hardened (lipodermatosclerosis), and may have a characteristic “inverted champagne bottle” shape to the lower leg. Significant weeping or exudate (drainage) is common with venous ulcers, often necessitating highly absorbent dressings.
Symptoms of Venous Ulcers
Pain from venous ulcers is typically described as dull aching, heaviness, or throbbing — usually worse when standing or sitting for long periods and improved with leg elevation. Many patients report that their wounds are painful but not the severe, unrelenting pain characteristic of arterial wounds. Leg swelling (edema) is almost universally present, and patients may notice that their skin itches or feels tight around the wound.
Treatment: Compression Is Central
The cornerstone of venous ulcer treatment is compression therapy — applying external pressure to the leg to counteract the high venous pressure that drives the wound. Compression bandaging, compression stockings, or pneumatic compression devices work by reducing venous hypertension, improving blood return, and decreasing edema and inflammation. Without adequate compression, venous ulcers will not heal regardless of how well the wound itself is dressed.
HarvardCare at Home’s skilled nurses provide expert compression therapy application and monitoring as part of our venous leg ulcer treatment at home service. Dressings for venous ulcers focus on moisture management — absorbing excess exudate while maintaining a moist wound environment that promotes healing. Our wound dressing changes at home service uses the most clinically appropriate materials for each patient’s wound characteristics.
Arterial Ulcers: Causes, Appearance, and Location
Arterial ulcers (also called ischemic ulcers) account for approximately 10–25% of leg ulcers and carry a much more serious prognosis than venous ulcers. They develop when arterial blood flow to the lower extremities is severely compromised — tissues literally die from lack of oxygen.
What Causes Arterial Ulcers?
The primary cause is peripheral artery disease (PAD), where atherosclerosis (plaque buildup) narrows or blocks the arteries supplying the legs. Risk factors for PAD and arterial ulcers include smoking (the strongest modifiable risk factor), diabetes, hypertension, high cholesterol, advanced age, and kidney disease. Arterial ulcers can also develop from arterial trauma, embolism, or vasculitis in less common cases. Patients with diabetes are at especially high risk because diabetes damages both the small arteries (microvascular disease) and the large arteries (macrovascular disease) simultaneously — this is why diabetic foot wounds often have both arterial and neuropathic components.
Where Arterial Ulcers Appear
Unlike venous ulcers, which cluster around the inner ankle, arterial ulcers tend to appear on the outer ankle, foot, toes, and heel — areas at the end of the arterial supply chain where blood flow is most compromised. They may also appear over bony prominences where pressure reduces already-poor perfusion, or at tips of toes where blood flow is minimal. In severe PAD, even a minor trauma — bumping a toe, wearing tight shoes — can trigger ulcer formation in a location that cannot heal due to inadequate circulation.
What Arterial Ulcers Look Like
Arterial ulcers have a very distinctive appearance. They tend to be well-defined, “punched out” wounds with sharp, regular edges — in contrast to the irregular edges of venous ulcers. The wound base is typically pale, grey, or yellow with little or no granulation tissue, reflecting the lack of blood flow needed to form new tissue. The surrounding skin is often pale, shiny, hairless, and cool to the touch — classic signs of poor arterial perfusion. Toes may appear dusky or cyanotic (bluish). In severe cases, the tissue surrounding the wound may be frankly necrotic (black eschar).
Symptoms of Arterial Ulcers
Arterial ulcer pain is characteristically severe and unrelenting. Patients often describe a burning, stabbing, or cramping pain that is worst at night or when the leg is elevated (because elevation further reduces blood flow to already-ischemic tissues). Relief often comes only by dangling the leg off the bed, which uses gravity to improve perfusion — a classic history that helps distinguish arterial from venous disease. Before ulceration develops, many patients with PAD experience intermittent claudication — leg cramping or pain with walking that resolves with rest — as the first symptom of inadequate arterial supply.
Treatment: Restore Blood Flow First
Arterial ulcers cannot heal without adequate blood flow, making vascular assessment and often vascular intervention the cornerstone of treatment. A vascular surgeon or interventional radiologist may perform angioplasty, stenting, or bypass surgery to restore circulation before wound healing is possible. Wound management for arterial ulcers focuses on preventing infection, protecting the wound from trauma, and keeping the wound environment stable while awaiting vascular intervention or palliation. Compression therapy — the foundation of venous ulcer treatment — is contraindicated in arterial ulcers and can cause catastrophic harm by further reducing perfusion to already-ischemic tissues.
Our wound care nurses are trained to recognize the signs of arterial insufficiency and will never apply compression to a wound with suspected arterial component without confirmed adequate perfusion by ABI (ankle-brachial index) testing. Our chronic wound care at home and non-healing wound care at home teams coordinate closely with vascular specialists throughout LA County. Visit our Medicare wound care Los Angeles page to learn more about our approach to complex wound management.
Mixed Arterial-Venous Ulcers
A significant proportion of leg ulcer patients — estimates range from 15–25% — have mixed arterial-venous disease, where both poor venous return and inadequate arterial perfusion contribute to wound formation. These wounds are the most challenging to treat because compression therapy (essential for venous wounds) must be carefully modified or avoided based on the degree of arterial compromise. Modified compression at lower pressures may be appropriate for mild arterial insufficiency, while severe arterial disease requires no compression at all.
Accurate diagnosis of mixed disease requires ABI testing and often additional vascular imaging. HarvardCare at Home’s certified wound care nurses assess each patient’s wound etiology carefully and coordinate with the patient’s vascular team when arterial disease is suspected. Learn more about our specialized wound care nurse at home service.
Side-by-Side Comparison
Location: Venous ulcers appear on the inner ankle/lower leg (gaiter zone). Arterial ulcers appear on the outer ankle, foot, toes, and heel.
Wound edges: Venous ulcers have irregular, sloping edges. Arterial ulcers have well-defined, “punched out” edges.
Wound base: Venous ulcers are red/pink with possible slough. Arterial ulcers are pale, grey, or yellow with minimal granulation.
Surrounding skin: Venous ulcers show brown-red discoloration, thickening, swelling. Arterial ulcers show pale, shiny, hairless, cool skin.
Pain pattern: Venous ulcers cause dull aching, worse with standing, better with elevation. Arterial ulcers cause severe pain, worse with elevation, better with leg dangling.
Exudate: Venous ulcers produce heavy drainage. Arterial ulcers produce minimal drainage.
Compression: Venous ulcers require compression as primary treatment. Arterial ulcers — compression is contraindicated.
Primary treatment goal: Venous ulcers — reduce venous hypertension. Arterial ulcers — restore arterial perfusion.
Medicare Coverage for Leg Ulcer Care at Home
Medicare covers skilled nursing wound care at home for both arterial and venous ulcers when you are homebound and require skilled nursing care — at $0 cost to qualifying patients. Coverage includes wound assessment and measurement at every visit, dressing changes using clinically appropriate materials, compression therapy application and monitoring (for venous wounds with adequate perfusion), debridement when indicated, patient and caregiver education, and coordination with your vascular physician or wound care specialist.
Under Medicare Part B’s surgical dressing benefit, wound dressings for qualifying wounds are also covered. Our venous leg ulcer treatment, chronic wound care, and infected wound care at home services are all available to Medicare patients throughout Los Angeles. Learn more about the full scope of coverage at our Medicare wound care in Los Angeles page, and review our guides on is home wound care covered by Medicare and the role of compression therapy in treating leg wounds.
When to Seek Professional Wound Care for a Leg Ulcer
You should seek professional wound care immediately if you have an open wound on your lower leg or foot that has not healed within 2–4 weeks, a wound that is increasing in size despite treatment, signs of infection (increased redness, warmth, swelling, pus, fever, or worsening odor), a wound associated with significant pain, any discoloration or darkening of the toes or foot, or a known history of diabetes, PAD, or venous insufficiency with a new wound. Early professional intervention significantly improves healing rates and reduces the risk of amputation. Read our guides on signs your wound is infected and why chronic wounds need professional care to heal.
How HarvardCare at Home Treats Leg Ulcers in Los Angeles
HarvardCare at Home’s certified wound care nurses are experienced in the assessment and treatment of both arterial and venous leg ulcers. We perform thorough wound assessments at every visit, use evidence-based dressing protocols matched to each wound type, apply and monitor compression therapy appropriately, coordinate with your vascular physician when arterial disease is suspected, and educate patients and caregivers on wound care, compression, positioning, and warning signs.
We serve leg ulcer patients throughout Los Angeles County — from Los Angeles and Burbank to Long Beach, Pasadena, Glendale, and beyond. To get started, visit our home health care page, contact our wound care team, or review our frequently asked questions.
