Venous ulcers are most likely located immediately posterior to which anatomical landmark?

• A. Medial malleolus
• B. Lateral malleolus
• C. Achilles tendon
• D. Tibial tuberosity

Answer: (A)

Venous ulcers arise from chronic venous insufficiency, which causes venous hypertension in the dependent portion of the leg. The most common site for this breakdown is the gaiter area around the medial malleolus, typically immediately posterior to it. Standing and walking increase venous pressure in the superficial system (especially the great saphenous vein), leading to edema, skin changes, and eventual ulceration in this region. The skin here is prone to damage from chronic edema and minor trauma, so ulcers form and persist there with irregular, shallow edges and hemosiderin staining. Sites near other landmarks are less characteristic for venous ulcers, which is why the medial malleolus area is the classic location.