17
Table 8. Alternative Diagnoses for Nonhealing Lower
Extremity Wounds With Normal Physiological
Testing (Not PAD Related)
Condition Location Characteristics and Causes
Autoimmune
injury
Toes, foot, leg • With blisters (eg, pemphigoid, pemphigus,
epidermolysis bullosa)
• Without blisters (eg, dermatomyositis, lupus,
scleroderma)
Infection Toes, foot, leg • Bacterial (eg, Pseudomonas, necrotizing
Streptococcus)
• Fungal (eg, blastomycosis, Madura foot,
chromomycosis)
• Mycobacterial
• Parasitic (eg, Chagas, leishmaniasis)
• Viral (eg, herpes)
Inflammatory
ulcer
Toes, foot, leg • Necrobiosis lipoidica
• Pyoderma gangrenosum
• Granuloma annulare
Local injury Toes, foot, leg • Trauma
• Insect or animal bite
• Burn
Malignancy Toes, foot, leg • Primary skin malignancy
• Metastatic malignancy
• Malignant transformation of ulcer
Medication-
related ulcer
Toes, foot, leg • Drug reactions (eg, erythema multiforme)
• Medication direct toxicity (eg, doxorubicin,
hydroxyurea, some tyrosine kinase inhibitors)
Neuropathic
ulcer
Pressure
zones of foot
• Hyperkeratosis surrounds the ulcer
• Diabetes with peripheral neuropathy
• Peripheral neuropathy without diabetes
• Leprosy
Venous ulcer Distal leg,
especially
above medial
malleolus
• Develops in regions of skin changes due to chronic
venous disease and local venous hypertension
• Typically wet (ie, wound drainage) rather than dry
lesion
Modified with permission from Gerhard-Herman MD, et al. Copyright © 2017 American
Heart Association, Inc., and American College of Cardiolog y Foundation.
