Where do ulcers typically occur in venous insufficiency?

• A. Anterior tibia
• B. Posterior calf
• C. Medial and tibial malleolus
• D. Lateral malleolus

Answer: (C)

Ulcers from venous insufficiency arise from chronic ambulatory venous hypertension that causes fluid and red blood cell leakage into the skin, leading to edema, stasis changes, and eventual breakdown. The medial malleolus region is the most common site because gravity promotes pooling of blood in the dependent ankle area, and the perforating veins draining into the superficial system are plentiful there, making this area especially vulnerable to valve incompetence and tissue breakdown. The skin around the medial malleolus is prone to edema, hemosiderin deposition, and dermatitis, all of which contribute to ulcer formation. Ulcers at the anterior tibia are more characteristic of arterial or pressure-related ulcers, while those at the posterior calf or lateral malleolus are not the typical venous ulcer location.