Leg Ulcers

Overview

A leg ulcer is an open sore on the lower leg that has not healed, usually between the knee and the ankle. It happens when the skin breaks down and the body cannot repair it quickly. Most leg ulcers are caused by poor blood flow in the veins of the leg, where blood does not flow back to the heart properly and pressure builds up in the lower leg. Others are caused by poor blood flow in the arteries (the vessels that bring blood down the leg), or by a mix of both. A leg ulcer is not just a cut or a graze — it is a wound that needs proper medical care to heal.

Yes. Leg ulcers are common, especially in older adults. They are one of the most frequent long-term wounds treated by community nurses and general practice teams.

Leg ulcers can affect adults of any age, but they are much more common in people over 60. They are more likely in people with varicose veins, a history of blood clots in the leg, swollen legs, limited mobility, diabetes, or poor circulation in the arteries. They are rare in children.

Symptoms

Common symptoms

• An open sore on the lower leg, often just above the ankle, that does not heal
• Skin around the sore may look red, shiny, dry, or itchy
• Brownish or dark staining of the skin near the sore, or hardened skin
• Swelling in the ankle and lower leg, worse at the end of the day
• Fluid or watery discharge from the wound, which may soak through a dressing
• Pain that feels better when the leg is raised, in ulcers caused by vein problems
• Pain that is worse at night or when the leg is raised, in ulcers caused by artery problems
• The leg may feel heavy, achy, or tight

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 that keeps coming back, it should be checked by a doctor.

Symptoms in older adults

• Older adults often have thinner, more fragile skin that tears and breaks more easily
• Healing can be slower because of other health conditions or reduced mobility
• Swollen legs and long periods of sitting or standing can make ulcers more likely
• Pain and reduced movement can affect sleep, mood, and independence, so extra support is often helpful

Causes

Main causes

• Vein problems (venous ulcers): valves in the leg veins do not close properly, so blood pools in the lower leg and pressure builds up. This damages the skin and slows healing. This is the most common cause.
• Artery problems (arterial ulcers): the arteries that carry blood down the leg become narrowed or blocked, so the skin does not get enough blood and oxygen to stay healthy.
• Mixed ulcers: a combination of vein and artery problems.
• Less common causes include long-standing pressure on the skin, nerve damage (for example from diabetes), inflammation of the blood vessels, and some skin conditions or medicines.

Risk factors

• Varicose veins or a history of blood clots in the leg
• Swollen legs or long periods of standing or sitting without moving
• Reduced mobility, such as using a wheelchair or being mostly bed-bound
• Diabetes
• Poor circulation in the arteries, or a history of heart attack or stroke
• Smoking
• Being overweight
• Increasing age, and having thin or fragile skin
• Previous leg ulcers — once you have had one, the risk of another is higher

When to see a doctor

See a doctor urgently if:

• Any new open sore on the leg that is not healing after a week or two
• Signs of infection: increasing pain, spreading redness, pus, bad smell, or fever
• Sudden increase in swelling, or the leg becoming very hot and tender
• Bleeding from the ulcer that keeps coming back
• A leg that is suddenly very painful, pale, or cold

Book a routine appointment if:

• You have had a leg ulcer before and notice the skin breaking down again
• Your legs feel heavy, ache, or swell often, even without an open sore
• You have varicose veins and want advice on protecting your skin
• Your dressing needs changing and you are not sure how to care for the wound
• Your ulcer is healing but you want to know how to lower the chance of it coming back

Diagnosis

A doctor or nurse will usually ask about your health history and examine the leg, the wound, and the skin around it. They will feel the pulses in your feet and look at the colour, temperature, and swelling of the leg. A key test is checking the blood pressure in your ankle compared with your arm, called an ankle-brachial pressure index (ABPI). This simple test helps show whether the blood supply to your leg is good enough to use compression treatment safely. Sometimes a wound swab is taken if infection is suspected.

Tests that may be done

• Physical examination of the leg, feet, and pulses
• Ankle-brachial pressure index (ABPI): a blood pressure check at the ankle and arm to assess circulation
• A wound swab if the ulcer looks or smells infected
• Blood tests, such as a check for diabetes or anaemia
• An ultrasound scan of the leg veins to look for vein problems
• Rarely, a small sample of tissue (biopsy) if an ulcer is not healing as expected

What to expect at your appointment

The assessment is usually painless, though examining the wound may feel tender. You may be asked to lie down and roll down your socks. You might be referred to a leg ulcer clinic or a community nursing team, who will see you regularly, change dressings, and check on healing. Photos or measurements of the wound may be taken to track progress.

Treatment

Treatment aims to help the wound heal, treat the underlying cause, relieve pain, and prevent the ulcer from coming back. The right plan depends on whether the problem is in your veins, your arteries, or both. Most people are cared for by a community nursing team or a leg ulcer clinic, working alongside your GP.

Self-care at home

• Keep your leg raised above the level of your heart when resting, for example on a stool or pillows — this helps reduce swelling
• Keep moving as much as you can. Walking helps the calf muscles pump blood back up the leg
• Follow the dressing and compression plan given by your nurse or doctor, and do not change it yourself
• Keep the skin around the ulcer moisturised with a plain, unperfumed cream, but avoid putting cream inside the wound
• Keep the dressing dry — use a waterproof cover when showering if advised
• Check your legs and feet daily for new cuts, redness, or swelling
• Avoid standing still for long periods, and avoid knocking or scratching your legs
• Wear comfortable, well-fitting shoes and socks that do not press on the wound

Medical treatments

The main treatment for vein-related ulcers is compression therapy — special bandages, stockings, or wraps that gently squeeze the leg to help blood flow back up towards the heart. Your care team will choose the type and strength and check it regularly. Wounds are cleaned and covered with dressings suited to the amount of fluid and the stage of healing. If the wound becomes infected, your doctor may prescribe medicines to treat infection. Pain relief may be suggested, and any underlying conditions such as diabetes or high blood pressure will be managed. If the blood supply in your arteries is poor, compression may not be safe, so circulation is checked first. Your care team will also teach you about leg care and how to lower the risk of future ulcers.

When is surgery considered?

Surgery is not needed for most leg ulcers, but it can help in some cases. If a vein problem keeps causing ulcers, a vascular specialist may offer treatment to close or remove the faulty veins. If the arteries are narrowed or blocked, a procedure to improve blood flow — such as stretching the artery with a small balloon or bypassing the blocked part — may be recommended. A skin graft may occasionally be used for a large or slow-healing wound. Your doctor will explain the benefits and risks and help you decide.

Living with this condition

Living with a leg ulcer usually means regular visits from a nurse or trips to a clinic for dressing changes, plus some changes at home. Leaking dressings, odour, and pain can be upsetting, but these are common and your care team can suggest better dressings and ways to cope. Many people keep working, exercising gently, and carrying on with daily life with some adjustments. Healing often takes weeks to months, so it helps to be patient, keep appointments, and ask questions when something is unclear.

Lifestyle tips

• Stay active — walking regularly supports circulation and helps wounds heal
• Raise your legs when resting, and avoid sitting with your feet down for long stretches
• If you smoke, getting support to stop is one of the best things you can do for your circulation
• Aim for a healthy weight, as this reduces pressure on the leg veins
• Wear compression stockings or bandages exactly as advised
• Protect your legs from knocks, sunburn, and very hot baths
• Check your feet and legs every day, and ask for help if you cannot see them well

Diet and exercise

There is no special diet that heals a leg ulcer, but eating well helps your body repair itself. Try to include protein at each meal — such as beans, lentils, eggs, fish, chicken, or dairy — along with plenty of fruit and vegetables, and drink enough water through the day. Gentle, regular movement is important: short walks, ankle circles, and moving your feet up and down while sitting all help the calf muscles push blood back up the leg. Your nurse or doctor can advise on safe activity if you have other health conditions.

Mental health and emotional wellbeing

Leg ulcers can affect how you feel. Pain, leaking wounds, odour, and the need for frequent appointments can cause embarrassment, frustration, worry, or low mood, and some people feel isolated or less confident. These feelings are common and worth talking about. Tell your nurse or doctor if you feel low, anxious, or hopeless — support is available, and treating mood is part of good care. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support line straight away.

Prevention

You cannot always prevent a leg ulcer, but you can greatly lower your risk. The key is looking after your leg veins and skin, staying active, and getting help early if the skin starts to break down. If you have had an ulcer before, your care team may recommend compression stockings and regular check-ups to help stop it coming back.

Vaccines

There is no vaccine for leg ulcers. Staying up to date with recommended vaccinations, such as tetanus and flu, is still part of general health care — ask your GP or pharmacist what is advised for you.

Screening programmes

There is no routine screening programme for leg ulcers. Instead, people with varicose veins, swollen legs, diabetes, or a previous ulcer are usually reviewed regularly by their GP or nurse. Checking your own legs and feet often is a simple and useful habit.

Complications

If left untreated

• The wound may get bigger, deeper, and much slower to heal
• Infection can spread into the skin and deeper tissues, and rarely into the bone
• Long-standing swelling and vein damage can cause permanent skin changes and hardening
• Reduced mobility and pain can affect sleep, work, and independence
• Bleeding from the wound can occasionally be heavy
• Ulcers that never heal over a very long time are sometimes checked with a biopsy, as a small number can hide other skin problems

Long-term outlook

The outlook is generally good. Most vein-related leg ulcers heal with proper care, often within a few months, though some take longer. Many people need ongoing leg care afterwards, because ulcers can return — but compression stockings, staying active, and regular check-ups make a real difference. Your care team will work with you on a plan that fits your life, and it is fine to ask questions or raise concerns at any point.

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