Venous leg ulcer
Venous leg ulcer
A leg ulcer is a wound that doesn't heal for a long time and can keep coming back. Most people notice it on the inner side of the leg, a little above the ankle.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
What causes a venous leg ulcer?
A venous leg ulcer can form after a small injury if the blood flow in your leg veins isn't working properly. When this happens, pressure builds up inside the veins.
Over time, this constant high pressure can damage the tiny blood vessels in your skin and make it fragile. That's why your skin can break easily after just a knock or scratch, turning into an ulcer.
If you don't get treatment to improve circulation in your legs, the ulcer may not heal.
Who's most at risk of a venous leg ulcer?
Several factors can raise your risk of developing a venous leg ulcer, including:
- Obesity or being overweight, which increases pressure in the leg veins
- Difficulty walking, which can weaken the calf muscles and affect circulation in the leg veins
- A previous deep vein thrombosis (DVT), where blood clots in the leg damage the valves in your veins
- Varicose veins, where swollen, enlarged veins are caused by valves that aren't working properly
- A previous leg injury, such as a broken or fractured bone, which may lead to DVT or affect how you walk
- Previous leg surgery, such as a hip or knee replacement, which can limit your movement afterward
- Increasing age, since some people find it harder to move around as they get older, especially if they have arthritis
Diagnosis
If you think you may have a venous leg ulcer, it's best to speak to your GP practice rather than wait and see. Left untreated without proper medical care, the ulcer is unlikely to heal on its own.
Your GP or nurse will start by talking through your symptoms and examining the affected leg. This is usually enough to diagnose a venous leg ulcer, though sometimes a few extra tests are needed to be sure.
Medical history and examination
Your GP or practice nurse will ask if you have other symptoms often linked with venous leg ulcers, such as:
- swelling in your ankles
- discoloured or hard skin
They will also try to find out what's causing the ulcer by asking about any underlying conditions or past injuries, for example:
- diabetes
- deep vein thrombosis (DVT)
- a previous injury or surgery on the affected leg
- an earlier leg ulcer
To get a fuller picture, they'll examine your leg both while you're standing and while you're lying down, and they'll check the pulse at your ankle to confirm the arteries in your leg are working as they should.
Doppler study
Your GP or nurse will also carry out a test known as a Doppler study. This helps rule out peripheral arterial disease, a condition that affects the arteries.
During this test, blood pressure is measured at your ankles and compared with the blood pressure in your arms. If the reading at your ankles is lower than at your arms, this can be a sign of peripheral arterial disease.
This check matters because the main treatment for venous ulcers, compression bandages or stockings, works by improving vein circulation in the leg. If the artery pressure in your ankle is low, applying compression would not be safe.
Referral to a specialist
In some cases, your GP or nurse might refer you to a vascular specialist, a doctor who focuses on conditions affecting the blood vessels.
This is more likely if there's uncertainty about your diagnosis, or if your ulcer is thought to be caused by something like:
- artery disease
- diabetes
- rheumatoid arthritis
If you're referred, the specialist will go through your medical history and examine you themselves, and may arrange further tests to help plan the right treatment for you.
Treatment
Treatment for venous leg ulcers
Most venous leg ulcers heal within 6 months with treatment.
Cleaning and dressing the ulcer
The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This provides the best conditions for the ulcer to heal.
A simple, non-sticky dressing will be used to dress your ulcer. This usually needs to be changed once a week. Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.
Compression
To improve vein circulation in your legs and treat swelling, your nurse will apply a firm compression bandage over the affected leg. These bandages are designed to squeeze your legs and encourage blood to flow upwards, towards your heart.
There are many different types of bandage or elastic stockings used to treat venous leg ulcers, which may be made in 2 to 4 different layers.
The bandage is changed once a week, when the dressing is changed.
When compression bandages are first applied to an unhealthy ulcer, it’s usually painful.
Ideally, you should have paracetamol or an alternative painkiller prescribed by your GP. You can get paracetamol from your local pharmacist or your GP. The pain will lessen once the ulcer starts to heal.
It’s important to wear your compression bandage exactly as instructed. If you have any problems, it’s usually best to contact your nurse, instead of trying to remove it yourself. If the compression bandage feels a little too tight and is uncomfortable in bed at night, getting up for a short walk will usually help.
However, you’ll need to cut the bandage off if:
- you get severe pain at the front of your ankle
- you get severe pain on the top of your foot
- your toes become blue and swollen
Once you remove the bandage, keep your leg elevated and contact your doctor or nurse as soon as possible.
In some clinics, specialist teams are using new alternatives to compression bandages. These include:
- special stockings
- other compressive devices
These may not be available in every clinic. Your specialist will be able to advise you whether a different approach may help you.
Looking after yourself during treatment
Do
- keep active by walking regularly
- keep your affected leg elevated – with your toes level with your eyes
- move your feet up and down, and rotate them at the ankles – this can help encourage better circulation
- maintain a healthy diet
- moderate your alcohol consumption
- wear comfortable, well-fitting footwear
Don’t
- do not smoke
Treatment for an infected ulcer
If your ulcer becomes infected, it should be cleaned and dressed as usual.
You should also elevate your leg most of the time and you’ll be prescribed a 7-day course of antibiotics.
Antibiotic treatment aims to clear the infection. However, antibiotics don’t heal ulcers and should only be used in short courses to treat infected ulcers.
What to do after a venous leg ulcer has healed
Once you’ve had a venous leg ulcer, another ulcer could develop.
The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed. Your nurse will help you find a stocking that fits correctly and that you can manage yourself.
Various accessories are available to help you put them on and take them off.
Prevention
There are ways to help lower your risk of getting a venous leg ulcer. For example, you could:
- wear compression stockings, which your GP may recommend
- manage your weight, since losing weight can help treat and prevent venous leg ulcers if you're obese or overweight
People who have had a leg ulcer before are most at risk of developing another one.
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