Leg ulcer

Venous leg ulcers are unhealed sores or open wounds on the legs. They occur in the presence of venous disease.

Man adjusting his sock

What is a leg ulcer?

Venous leg ulcers usually develop on the inside, sometimes on the outside of the leg, just above the ankle.

The symptoms of a venous leg ulcer include

  • pain
  • itching
  • swelling

in the affected leg. There may also be discolored or hardened skin around the ulcer, and the sore may produce a foul-smelling discharge.

Venous disease is the main reason for over two thirds of all leg ulcers. Other common types of leg ulcer include:

  • arterial leg ulcers – caused by poor blood circulation in the arteries
  • diabetic leg ulcers – caused by the high blood sugar associated with diabetes
  • vasculitic leg ulcers – associated with chronic inflammatory disorders such as rheumatoid arthritis and lupus
  • traumatic leg ulcers – caused by injury to the leg
  • malignant leg ulcers – caused by a tumor of the skin of the leg

Most ulcers caused by artery disease or diabetes occur on the foot rather than the leg.

A venous leg ulcer is generally a sign of severe venous disease

Venous leg ulcers are one of the most serious results of the progression of chronic venous disease; they are often chronic and difficult to heal. In fact, the recurrence rate of venous leg ulcers is more than 70 percent.

See your physician if you think you have a leg ulcer, as it will need professional treatment to help it heal. Your doctor can also help determine the type of ulcer you have and the best treatment option.

What causes a venous leg ulcer?

Venous leg ulcers result from progression of venous disease, notably chronic venous insufficiency (CVI).

Chronic venous insufficiency is a condition that occurs when the venous walls and/or valves in the leg veins are damaged or not working effectively.

The valves should ensure that blood flows up the leg, not down. If they are not closing properly, the blood stagnates in the veins, resulting in very high pressure in the veins when in an upright position.

This constant high pressure can gradually damage the tiny blood vessels in your skin, leading to leakage of blood into the tissue. This eventually leads to local inflammation of the tissue.

A minor injury can cause a leg ulcer

A venous leg ulcer can develop after a minor injury if there's a problem with the circulation of blood in your leg veins and a local inflammation of the tissue has started to develop.

As a result, your skin can easily break and form an ulcer after a knock or scratch.

Unless you have treatment to improve the circulation in your legs, the ulcer may not heal.

How is a venous leg ulcer diagnosed?

It is recommended to take a close look at the medical history for all ulcer patients:

  • personal or familiar history of varicose veins, treated or not
  • personal or family history of deep vein thrombosis and/or superficial vein thrombosis and/or pulmonary embolism
  • personal history of significant trauma or lower limb surgery
  • a previous venous ulcer
  • presence of diabetes

Your health care professional will examine your leg, both when you’re standing up and lying down.

The’ll also feel your pulse at the ankles to make sure the arteries in your leg are working properly. To rule out peripheral arterial disease (a condition affecting the arteries) as a possible cause of your symptoms, your health care professional will carry out a test known as a Doppler study.

Further examinations might be done in order to assess the blood flow in your veins.

What is the treatment for leg ulcer?

If you are diagnosed with venous leg ulcer, you are probably already working closely with a wound clinic or your physician in the management of the wound.

Control and heal the wound: medical compression plays an important rule

The primary treatment of a venous leg ulcer includes controlling any infection and healing the wound. This may take several months, depending of the size of the wound. Managing pain and minimizing the oedema as well as protecting the healthy skin are important.

Compression helps to improve vein circulation in your legs and to treat swelling. It plays an important role in the healing of your wound and in post-wound care.

Traditionally, short-stretch compression bandages are used in the initial phase of treatment of large ulcers until healing is nearly complete or the patient can be fitted in a knee-length graduated compression stocking at 30–40 mmHg or higher.

Compression stocking systems

Also, compression stocking systems are available. They consist of a normal compression stocking and a patented low-compression understocking. These systems offer many benefits above and beyond those of bandages:

  • Easy to don, meaning that assistance with compression treatment is not required in many instances
  • Comfortable and discreet, even with shoes
  • No unpleasant pressure when lying in bed, as only the understocking is worn at night
  • The understocking keeps the wound dressing in place while you are sleeping
  • No damage to the wound when applied correctly – neither when donning nor doffing the stocking

With appropriate treatment, most venous leg ulcers heal within 3 to 4 months. 

Once your wound is healed, you should continue wearing your compression stockings for life to prevent development of another ulcer.

Summary

Leg ulcer is the most serious consequence of venous disease. 

Basic medical knowledge on venous disorders

  • With the term Chronic Venous Disorder (CVD) we describe a long-standing condition involving impaired venous return.
  • If vein valves don’t close properly, a reflux results: the blood leaks downwards and stagnates in the vein, thereby leading to venous hypertension. This condition is known as chronic venous insufficiency (CVI) which may cause edema, skin change, and, in some cases, ulcerations.
  • If left untreated, chronic venous insufficiency can result in the formation of serious disorders, including phlebitis and pulmonary embolism. To distinguish the different manifestations of CVD, the CEAP classification system is used.
  • Acute venous disorders usually occur without pre-existing conditions, but they can also be triggered by chronic venous disorders. In any case, medical treatment is immediately required. Acute venous disorders include superficial thrombophlebitis, deep vein thrombosis (DVT), pulmonary embolism, post-thrombotic syndrome, and variceal bleeding.
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