Final answer:
The patient is likely dealing with a venous ulcer, given the symptoms and normal Ankle Brachial Index (ABI). The hemoglobin A1C level indicates a pre-diabetic state which might affect wound healing and contribute to the presence of the ulcer.
Step-by-step explanation:
A patient presenting with an ulcer near the ankle, experiencing pain upon standing that diminishes with ambulation, and having an Ankle Brachial Index (ABI) of .95 and hemoglobin A1C of 5.8% is most likely dealing with a venous ulcer. Given the ABI which is within the normal range, arterial disease is less likely. The hemoglobin A1C level is not indicative of poorly controlled diabetes, but it does show that the patient has some degree of elevated blood glucose levels, even if they don't currently meet the threshold for a diagnosis of diabetes. Additionally, considering the ulcer's location and the symptom relief upon ambulation, it aligns with the presentation of venous insufficiency where the pain is often reduced when walking as this action promotes circulation and reduces venous pressure.
On the other hand, if this were an arterial ulcer, one would expect the ABI to be lower than .9, demonstrating diminished arterial flow. In this scenario, pain would typically increase with ambulation due to the increased demand for blood flow that is not being met. With a hemoglobin A1C level of 5.8%, the patient appears to be in a pre-diabetic state, which suggests that his blood sugar has been consistently on the high side of normal. This elevated blood sugar can affect wound healing, hence the presence of an ulcer.