Leg Ulcer

Overview

A leg ulcer is an open sore on the leg that does not heal quickly. Most appear between the knee and the ankle, usually on the inside of the lower leg. They happen when the skin breaks and the body cannot heal it fast enough, often because blood is not moving well through the veins or arteries in the leg. A leg ulcer is not the same as a small cut or scrape. It can take weeks or even months to heal, and it often comes back without the right care.

Yes, leg ulcers are common. They are one of the most frequent long-term wounds treated by nurses, and they become more common as people get older.

Leg ulcers mostly affect adults over 60. They are more common in people who have varicose veins, have had a blood clot in the leg, have trouble moving around, or have diabetes. They are rare in children.

Symptoms

Common symptoms

• An open sore on the lower leg, usually between the knee and the ankle
• Skin around the sore that looks red, brown, or dark, and may be itchy or dry
• Swelling in the leg and ankle, often worse at the end of the day
• Aching, heaviness, or pain in the leg
• Fluid or wetness leaking from the sore that soaks through dressings
• Hard, tight skin on the lower leg
• An odour from the sore, which can feel embarrassing

Symptoms in children

• Leg ulcers are rare in children. If a child has an open sore on the leg that is not healing, or a sore with fever or spreading redness, get medical help the same day. Sores in children can have different causes, so a doctor should check them.

Symptoms in older adults

• Older adults are the group most often affected by leg ulcers
• Skin gets thinner and more fragile with age, so a small knock can turn into a sore
• Swelling and vein problems are more common
• Healing can be slower, so regular follow-up matters
• Ask for help if pain, dressings, or bandages are hard to manage at home

Causes

Main causes

• Venous ulcers (the most common): valves inside the leg veins stop working well, so blood pools in the leg and pressure builds up. This damages the skin and lets a sore form.
• Arterial ulcers: arteries that bring blood down to the leg are narrowed, so the skin does not get enough oxygen and heals poorly.
• Mixed ulcers: a combination of vein and artery problems.
• Other causes: long stays in bed or a wheelchair, nerve damage, some inflammatory skin conditions, and, rarely, other diseases.

Risk factors

• Being over 60
• Varicose veins, or a past blood clot in the leg (called a DVT)
• Standing still for long periods, or limited walking
• Being overweight
• Diabetes
• Smoking
• Swollen legs or lymphoedema, which is a build-up of fluid in the tissues
• Previous injury or surgery on the leg
• Heart problems or high blood pressure
• Not being able to move much, for example after a stroke or with arthritis
• Fragile, thin skin that tears easily

When to see a doctor

See a doctor urgently if:

• Any sore on your leg that has not started to heal after 2 weeks
• A sore that is getting bigger, more painful, or smelly
• Redness, warmth, or swelling spreading up the leg
• Fever, or feeling generally unwell
• Bleeding from the sore
• A leg that is suddenly swollen or painful

Book a routine appointment if:

• You have varicose veins and your legs ache, swell, or the skin is changing colour
• You have had a leg ulcer before and notice skin changes or a new break in the skin
• You would like advice on preventing another ulcer
• Your dressings or bandages need changing and you are not sure how to do it

Diagnosis

A doctor or nurse will look at the sore and the skin around it, ask about your health and any medicines you take, and check the pulses in your feet. They will also check how well blood flows through your leg. This matters because it decides whether firm compression bandages are safe for you.

Tests that may be done

• Ankle-brachial pressure index (ABPI): a simple test that compares blood pressure in your ankle with your arm to check blood flow in the leg
• Doppler ultrasound: a painless scan that shows how blood is flowing in your veins and arteries
• Blood tests to check for diabetes, anaemia, or infection
• A swab from the sore if it looks infected
• A small tissue sample (biopsy) if the sore is not healing as expected

What to expect at your appointment

The visit is usually quick. Apart from the sore itself, the tests are painless. You will likely need to come back for dressing changes and to have your bandages checked. Write down your questions beforehand and ask how long healing might take and who will look after your dressings.

Treatment

Treatment aims to heal the sore, treat infection if it is there, ease pain and swelling, and stop the ulcer coming back. Most people are looked after by a nurse in a leg ulcer clinic or at home, working with their doctor. Healing usually takes weeks to months and needs steady, regular care.

Self-care at home

• Rest with your leg raised above the level of your heart when you sit or lie down
• Keep moving as much as you can. Walking helps blood flow back up your legs
• Wear your compression bandages or stockings exactly as your nurse tells you
• Keep the skin around the sore clean and moisturised with products your nurse recommends
• Do not pick at the sore or put home remedies on it
• Wear comfortable shoes and loose clothing that does not press into your skin
• Check your legs and feet every day for new cuts, redness, or swelling
• Take pain relief as advised by your doctor or pharmacist

Medical treatments

The main treatment for most leg ulcers is compression therapy. This means firm bandages or stockings that gently squeeze the leg and help blood flow back up towards the heart. Your nurse will clean the sore and cover it with a dressing chosen to suit how wet or dry it is. If the sore is infected, your doctor may prescribe antibiotics. Other treatments can help with pain, swelling, and healing, and your care team will explain which ones suit you. Never change or stop a treatment on your own without asking your team first.

When is surgery considered?

Surgery is only needed for some people. It may be offered if a vein problem can be repaired to lower the chance of the ulcer coming back, if a skin graft is needed to close a large sore, or if an artery is narrowed and needs to be widened. Your specialist team will talk through the risks and benefits with you.

Living with this condition

Living with a leg ulcer can be tiring. Dressings and bandages need regular changes, and you may need help getting to appointments. Try to build rest with your leg raised into each day, and keep a note of how the sore looks so you can spot changes early. Ask your nurse to show you or a family member how to manage things at home.

Lifestyle tips

• Stay active: gentle walking and ankle exercises help blood flow
• Work towards a healthy weight if you can
• If you smoke, ask for help to stop. It is one of the best things you can do for healing
• Avoid standing still for long periods
• Wear well-fitting, flat shoes
• Protect your legs from knocks and sunburn

Diet and exercise

Eat a balanced diet with enough protein, fruit, and vegetables to support healing, and drink enough water. Gentle exercise such as walking, plus simple ankle pumps and circles, helps blood move up your legs. Build up slowly and stop if you get pain. Ask your nurse or physiotherapist what is safe for you, especially if you have artery problems.

Mental health and emotional wellbeing

Leg ulcers can affect how you feel. Pain, smell, and frequent appointments can leave you feeling low, embarrassed, or isolated. These feelings are common and worth talking about. If you feel you cannot cope, or you have thoughts of harming yourself, contact your doctor, your local mental health service, or your local crisis line straight away. In an emergency, call your local emergency number.

Prevention

You cannot always prevent a leg ulcer, but you can lower your risk a lot. The most important step after healing is to wear compression stockings if your nurse or doctor advises it, because this greatly lowers the chance of the ulcer coming back.

Vaccines

There is no vaccine for leg ulcers. Keep up with your routine vaccinations and ask your doctor if you need a booster after a skin injury.

Screening programmes

There is no routine screening programme for leg ulcers. If you have varicose veins, swollen legs, or a previous ulcer, ask your doctor to check your legs and blood flow.

Complications

If left untreated

• The ulcer may get bigger and take much longer to heal
• Infection can spread into the skin and deeper tissues
• Scarring, and stiff, discoloured skin on the lower leg
• A higher chance of the ulcer coming back
• Less mobility, and a drop in confidence
• Rarely, a sore that never heals can lead to more serious skin changes

Long-term outlook

Most leg ulcers heal with good care, although it can take weeks to months. Many people then need to keep wearing compression and keep an eye on their legs to stop a new sore forming. With a steady routine and a care team you trust, most people get back to their normal activities.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.