Predisposing Factors Peripheral vascular Diabetic patient with Valve incompetence disease (PVD) peripheral neuropathy in perforating veins Diabetes mellitus History of deep vein Advanced Age thrombophlebitis and thrombosis Previous history of ulcers Obesity Advanced age Anatomic Location Between toes or tips On plantar aspect of On medial lower led of toes foot and ankle Over phalangeal Over metatarsal On malleolar area heads heads Around lateral Under heel malleolus At sites subjected to trauma or rubbing of footwear Wound Characteristics Even wound margins Even wound margins Irregular wound Gangrene or necrosis Deep wound bed margins Deep, pale wound Cellulitis or underlying Superficial wound bed osteomyelitis Ruddy, granular Blanched or purpuric Granular tissue tissue periwound tissue present unless PVD is Usually no pain Severe pain present Frequently moderate Cellulitis Low to moderate to heavy exudate Minimal exudate drainage Patient Assessment Thin, shinny, dry skin Diminished or absent Firm edema Hair loss on ankle & sensation in foot Dilated superficial foot Foot deformities veins Thickened toenails Palpable pulses Dry, thin skin Pallor on elevation Warm foot Evidence of healed and dependent rubor Subcutaneous fat ulcers Cyanosis atrophy Periwound and leg Decreased hyperpigmintation temperature Possible dermatitis Absent or diminished pulses