10
Diagnosis
Table 8. Alternative Diagnoses for Non-healing Wounds With
Normal Physiological Testing (Not PAD-Related)
Condition Location Characteristics and Causes
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 (i.e., wound drainage) rather
than dry lesion
Distal small
arterial occlusion
(microangiopathy)
Toes, foot, leg • Diabetic microangiopathy
• End-stage renal disease
• Thromboangiitis obliterans (Buerger's)
• Sickle-cell anemia
• Vasculitis (e.g., Churg-Strauss, Henoch-
Schönlein purpura, leukocytoclastic
vasculitis, microscopic polyangiitis,
polyarteritis nodosa)
• Scleroderma
• Cryoagglutination
• Embolic (e.g., cholesterol emboli,
thromboemboli, endocarditis)
• Thrombotic (e.g., antiphospholipid
antibody syndrome, Sneddon's syndrome,
warfarin skin necrosis, disseminated
intravascular coagulation, livedoid vasculitis,
protein C or S deficiency, prolonged
vasospasm)
Local injury Toes, foot, leg • Trauma
• Insect or animal bite
• Burn
Medication
related
Toes, foot, leg • Drug reactions (e.g., erythema multiforme)
• Medication direct toxicity (e.g.,
doxorubicin, hydroxyurea, some tyrosine
kinase inhibitors)
Neuropathic Pressure zones
of foot
• Hyperkeratosis surrounds the ulcer
• Diabetes mellitus with peripheral
neuropathy
• Peripheral neuropathy without diabetes
mellitus
• Leprosy
