Ulceration of the lower limbs can be caused by either venous or arterial insufficiency, or a combination of the two. This is by far the most common cause. In this discussion, we will review the anatomy and physiology of the arterial and venous systems, as well as discuss the common pathophysiology that leads to ulceration. The existing evidence base will be investigated, and best management practices will be linked to provide specifics regarding when escalation is required.