Underlying vascular and mechanical commonalities of venous leg ulcers and diabetic foot ulcers: a unified framework for management

OBJECTIVE: Venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs) represent major global health challenges, affecting 1-4% of the global population and 25% of individuals with diabetes, respectively. While VLUs arise from chronic venous insufficiency and DFUs from diabetes-related micro/macrovascular complications, both conditions share critical pathophysiological mechanisms. This study explores the vascular and mechanical commonalities between VLUs and DFUs in order to propose an integrated, multidisciplinary approach to sustained ulcer care. METHOD: A structured narrative review was conducted using PubMed (2010-2026), to synthesise evidence on shared vascular and mechanical pathways of VLUs and DFUs, and the evidence was used to construct a framework. In addition, two illustrative clinical cases were analysed to highlight multidisciplinary management strategies. RESULTS: Both VLUs and DFUs exhibit microvascular dysfunction, endothelial damage and chronic inflammation, driven by mechanical stress and vascular abnormalities. The first case study demonstrates the coexistence of neuropathic and VLUs in a patient with diabetes, highlighting the need for comprehensive vascular and biomechanical evaluations. The second case study illustrates how lifestyle modifications (e.g., nocturnal recumbency, increased walking) can resolve hard-to-heal VLUs in a patient with severe post-thrombotic syndrome. CONCLUSION: A unified framework targeting shared vascular and mechanical pathways could improve healing, prevent recurrence and optimise resource allocation for both VLUs and DFUs. Future research should focus on personalised biomechanical assessments and therapies modulating common pathways.