Focused shockwave therapy for Venous / arterial ulcers.

Venous ulcers commonly occur on the inside of the lower leg, between the knee and ankle.

Arterial ulcer symptoms can include a wound that is slow to heal or does not heal; pain in the foot or leg, which may be worse when the leg is elevated; pain in the foot at rest in more advanced disease; cold feet or toes; pale, blue or otherwise altered skin colour; reduced hair growth on the lower leg or foot; shiny or thin-looking skin; a wound affecting the foot, toes or pressure areas; and reduced pulses in the foot.

Arterial ulcers are associated with reduced blood supply and can indicate significant peripheral arterial disease.

Persistent high pressure within the veins can affect the skin and underlying tissues, making them more vulnerable to ulceration.

Arterial ulcers occur when the arteries cannot deliver sufficient blood to the tissues. Common contributing factors include peripheral arterial disease, smoking, diabetes, high blood pressure, high cholesterol, cardiovascular disease, increasing age and previous vascular disease.

Reduced blood flow can limit the oxygen and nutrients available to the tissues, making wounds more difficult to heal.

Some ulcers have mixed venous and arterial causes, making accurate vascular assessment particularly important before treatment is started.

Your Advanced Clinical Pharmacist may also assess the circulation to your legs and feet. This can include checking pulses and measuring arterial blood flow using an ankle-brachial pressure index (ABPI) or other vascular tests. Further vascular investigations, such as duplex ultrasound, may be required depending on the findings.

If you have a persistent leg or foot ulcer, you can arrange a consultation with our Advanced Clinical Pharmacist to discuss your symptoms and have the affected area assessed.

Your Advanced Clinical Pharmacist can help identify the likely underlying cause of the ulcer and discuss appropriate treatment or referral where required.

Arterial ulcers — treatment focuses on improving blood supply and protecting the affected tissue. This may include: vascular assessment (determining the severity and location of arterial disease); risk-factor management (addressing smoking, blood pressure, cholesterol, diabetes and other cardiovascular risk factors); wound care (appropriate wound management and protection); vascular intervention (where necessary, vascular procedures may be considered to improve blood flow); exercise therapy (appropriate supervised exercise may form part of treatment for peripheral arterial disease); pain management (particularly where arterial insufficiency is causing significant pain); and specialist wound care (complex or non-healing arterial ulcers may require multidisciplinary vascular and wound-care management).

Focused Shockwave Therapy should not be presented as a routine treatment for venous or arterial ulcers.

The priority for an ulcer is to identify and treat the underlying vascular problem, provide appropriate wound care and address factors preventing healing. In particular, significant arterial insufficiency requires vascular assessment and may require restoration of blood flow before other treatments are considered.

If a patient has a separate musculoskeletal condition around the affected limb, Focused Shockwave Therapy may potentially be considered for that condition following an appropriate clinical assessment. It should not replace vascular assessment or established wound management.

If you develop a new ulcer, rapidly increasing pain, spreading redness or swelling, significant changes in skin colour or temperature, a cold or numb foot, or symptoms suggesting infection, seek prompt medical assessment. A suspected arterial ulcer or significant reduction in blood supply may require urgent vascular assessment.