What Is a Leg Ulcer?

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

Symptoms of a venous leg ulcer may include pain, itching and swelling in the affected leg. The skin around the ulcer may also become discoloured or hardened, and the wound may produce an unpleasant-smelling discharge.

Vein disease is the underlying cause of more than two-thirds of all leg ulcers. Other common types of leg ulcers include:

  • arterial leg ulcers – caused by reduced blood flow in the arteries

  • diabetic leg ulcers – associated with diabetes and high blood sugar levels

  • vasculitic leg ulcers – associated with chronic inflammatory conditions such as rheumatoid arthritis and lupus

  • traumatic leg ulcers – caused by an injury to the leg

  • malignant leg ulcers – caused by skin cancer or other malignant skin conditions affecting the leg

Most ulcers caused by arterial disease or diabetes develop on the foot rather than the leg.

A venous leg ulcer is generally a sign of advanced vein disease.

Venous leg ulcers are among the most serious complications of advanced chronic vein disease. They are often chronic and can be difficult to heal. In fact, more than 70% of venous leg ulcers recur.

If you think you have a leg ulcer, consult your doctor. Professional treatment is essential to support healing. Your doctor can also determine the type of ulcer and recommend the most appropriate treatment option.

What Causes Venous Leg Ulcers?

Venous leg ulcers develop as a result of the progression of vein disease, particularly chronic venous insufficiency (CVI).

Chronic venous insufficiency occurs when the vein walls and/or valves in the leg veins are damaged or do not function properly.

Healthy vein valves help keep blood flowing upward toward the heart. When they no longer close properly, blood flows backward and pools in the veins. This increases venous pressure when standing.

Over time, this persistently elevated pressure can damage the tiny blood vessels in the skin, allowing blood and fluid to leak into the surrounding tissue. This eventually leads to localized tissue inflammation.

Even a Minor Injury Can Cause a Leg Ulcer

A venous leg ulcer can develop after even a minor injury if blood flow in the leg veins is impaired and localized tissue inflammation has already developed. As a result, the skin becomes more fragile, and even a small bump or scratch can lead to the formation of an ulcer.

  • If blood flow in your legs is not improved through appropriate treatment, the ulcer may not heal.

How Is a Venous Leg Ulcer Diagnosed?

For all patients with a leg ulcer, a detailed medical history is recommended, including:

  • a personal history of significant trauma or surgery involving the lower limbs


Your doctor will examine your leg while you are both standing and lying down.

They will also check the pulse at your ankles to make sure the arteries in your legs are functioning properly. To rule out peripheral arterial disease as a possible cause of your symptoms, your doctor may perform a Doppler ultrasound examination.

Additional tests may also be performed to assess blood flow in your veins.

How Is a Leg Ulcer Treated?

If you are diagnosed with a venous leg ulcer, you will likely work closely with your doctor and a wound care clinic throughout your treatment. You may also be referred to a certified orthotist for compression therapy and ongoing care.

Wound Management and Healing: The Role of Medical Compression

The primary goals of treating a venous leg ulcer are to control infection and promote wound healing. Depending on the size of the wound, this process may take several months. During this time, pain management, reducing edema and protecting the surrounding healthy skin are also important.

Medical compression helps improve venous circulation in the legs and manage swelling. It plays an important role in wound healing and ongoing care.

Traditionally, short-stretch compression bandages are used during the initial treatment of larger ulcers until the wound has nearly healed or the patient can be fitted with a knee-high graduated compression stocking providing 30–40 mmHg or higher compression.

Compression Stocking Systems

Compression stocking systems are also available. They consist of a standard compression stocking and a patented low-compression liner. These systems offer several advantages over traditional compression bandages:

  • Easy to put on, reducing the need for assistance with compression therapy in many cases

  • Comfortable and discreet, even when worn with shoes

  • Greater comfort while lying in bed, as only the patented liner is worn at night

  • The liner helps keep the wound dressing securely in place while sleeping

  • When used correctly, the system helps minimize the risk of disturbing the wound during application or removal of the compression stocking

With appropriate treatment, most venous leg ulcers heal within three to four months.

Once your wound has healed, long-term use of compression stockings may be recommended to help reduce the risk of another venous leg ulcer.

Summary

Leg ulcers are one of the most serious complications of vein disease.

Understanding vein disease

  • The term chronic vein disease describes a long-term condition in which venous return is impaired.

  • When vein valves do not close properly, reflux occurs. Blood flows downward and pools in the vein, leading to venous hypertension. This condition is known as chronic venous insufficiency (CVI) and can lead to edema, skin changes and, in some cases, venous leg ulcers.

  • If left untreated, chronic venous insufficiency can lead to serious complications, including phlebitis and pulmonary embolism. The CEAP classification system is used to classify the different stages and forms of chronic vein disease.

  • Acute vein diseases usually occur without pre-existing vein disease, but they can also develop as a complication of chronic vein disease. In all cases, prompt medical attention is required. Acute vein diseases include superficial thrombophlebitis, deep vein thrombosis (DVT), pulmonary embolism, post-thrombotic syndrome and bleeding varicose veins.

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