Table 6. Alternative Diagnoses for Nonhealing Wounds With Normal Physiological Testing (Not PAD-Related).

Condition	Location	Characteristics and Causes
Venous ulcer	Distal leg, especially above medial mellolus	Develops in regions of skin changes due to chronic venous disease and local venous hypertension Typically wet (ie, wound drainage) rather than dry lesion
Distal small arterial occlusion (microangiopathy)	Toes, foot, leg	End-stage renal disease Thromboangiitis obliterans (Buerger's) Sickle-cell anemia Vasculitis (eg, Churg-Strauss, Henoch-Schonlein purpura, leukocytoclastic vasculitis, microscopic polyangiitis, polyarteritis nodosa) Scleroderma Cryoagglutination Embolic (eg, cholesterol emboli, thromboemboli, endocarditis) Thrombotic (eg, 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 (eg, erythema multiforme) Medication direct toxicity (eg, 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
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)
Malignancy	Toes, foot, leg	Primary skin malignancy Metastatic malignancy Malignant transformation of ulcer
Inflammatory	Toes, foot, leg	Necrobiosis lipoidica Pyoderma gangrenosum Granuloma annulare

PAD indicates peripheral artery disease.