Where do venous ulcers most commonly occur?

• A. Medial and tibial malleolus.
• B. Lateral malleolus.
• C. Dorsum of foot.
• D. Posterior knee.

Answer: (A)

Venous ulcers arise from chronic venous insufficiency that creates venous hypertension in the dependent leg, leading to skin breakdown most commonly in the gaiter region around the medial malleolus. The inner ankle area accumulates edema and has fragile skin, making it particularly vulnerable to breakdown and ulceration, often with accompanying signs like hemosiderin staining and lipodermatosclerosis. That’s why the medial malleolus is the classic site. Ulcers on the dorsum of the foot are more typical of neuropathic or pressure-related causes, and ulcers around the lateral malleolus or behind the knee are less characteristic of venous disease.