- pts complain of pain, cramping, burning, aching, worse with elevation. - wounds appear more regular, may be due to trauma, granulation tissue will be pale if present, perhaps black eschar, perhaps gangrene, little drainage. - surrounding skin will be thin and shiny, absent hair growth, thickened and yellow nails, pale, dusky or cyanotic skin - decreased or absent pedal pulses - cooler to touch - keys to healing ulcers: moisturize dry skin, avoid adhesives, reduce friction on skin, pad ischemic tissues, keep wound bed moist, debride necrotic tissue when present, avoid compression, choose footwear carefully, pt education