Pressure Ulcer Basics: Conditions Confused with PU

A photo of a foot with acute limb ischaemia.

Acute limb ischemia
This is a picture of a foot with acute limb ischaemia. The features that primarily differentiate it from a PU are the lack of history of immobility, coupled with the circumferential nature of the tissue necrosis.

Peripheral vascular disease and inotropes can create confusion as they divert blood away from the peripheral areas. This can lead to changes in skin colour to fingers and toes that causes confusion with some signs of PUs.

photos of a person with renal and secondary arterial impairment.

Arterial disease of the toes
This series of slides comes from a patient with renal and secondary arterial impairment.

While the lesions on both feet were recorded as a PU, the characteristics do not match the characteristics of a Stage 4 PU. The slides demonstrate the defining characteristics of arterial disease including:

thickened toe nails
necrosis
mottled colour of the skin
generalised gross oedema
peeling and thickened skin.

These slides highlight the need to ascertain a complete clinical picture to assist with the accurate diagnosis of PUs.


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