Venous leg ulcers

Overview

Venous leg ulcers are open sores on the lower leg that happen when the veins in your legs cannot pump blood back to your heart properly. This causes blood to pool and pressure to build up, leading to skin damage and a sore that is slow to heal.

Yes, venous leg ulcers are fairly common, especially in older adults.

They most often affect people over 60, but can occur at any age. They are more common in women and in people who have had blood clots or varicose veins.

Symptoms

Common symptoms

• Aching, heavy feeling in the leg
• Swelling in the leg or ankle
• Red, flaky, or itchy skin around the sore
• A shallow sore with a red, moist base and sometimes yellow or green discharge
• Mild pain that gets better when you lift your leg up

Symptoms in children

• Venous leg ulcers are very rare in children.

Symptoms in older adults

• Same as common symptoms, but older adults may have less pain or more difficulty moving.
• The skin around the ulcer may become hard and dark in color over time.

Causes

Main causes

• Damaged or weak valves in the leg veins that allow blood to flow backward and pool
• Deep vein thrombosis (blood clot in a deep vein) that damages the vein walls

Risk factors

• Being over 60
• Being female
• Having varicose veins
• Having had a blood clot in the leg
• Obesity
• Lack of movement (sitting or standing for long periods)
• Previous leg injury or surgery
• Pregnancy

When to see a doctor

See a doctor urgently if:

• If you have signs of a skin infection (redness, warmth, fever)
• If the ulcer is very painful or bleeding

Book a routine appointment if:

• As soon as you notice a sore on your leg that does not heal within a few weeks

Diagnosis

A doctor or nurse will examine your leg and ask about your health history. They may check the pulses in your feet to make sure your arteries are healthy.

Tests that may be done

• Doppler ultrasound — a painless test using sound waves to check blood flow in your veins and arteries
• Ankle-brachial pressure index (ABPI) — a test that compares blood pressure in your ankle and arm to check for artery disease

What to expect at your appointment

The doctor or nurse will measure the ulcer, look at the skin around it, and ask about your symptoms. They may refer you to a specialist wound care clinic.

Treatment

The main treatment is compression therapy — wearing special bandages or stockings that squeeze your legs and help blood flow back to your heart. You will also need regular cleaning and dressing of the ulcer.

Self-care at home

• Keep your leg elevated (above your heart) as often as possible, especially when sitting
• Stay active and walk regularly to help your calf muscles pump blood
• Wear compression stockings or bandages as prescribed — do not remove them without advice
• Keep the skin around the ulcer clean and moisturized (but not on the open wound)
• Eat a healthy diet with plenty of protein and vitamins to help healing

Medical treatments

A healthcare professional will clean the ulcer and apply a dressing. They may use special wound care products, such as hydrogel or foam dressings. If there is infection, they may prescribe antibiotics. Sometimes a topical gel or ointment is used to help the wound heal. They will also treat the underlying vein problem, for example with endovenous ablation (using heat or glue to close damaged veins) or sclerotherapy (injecting a solution into the vein).

When is surgery considered?

Surgery may be recommended if compression therapy is not helping or if the vein problem can be fixed. This can include vein stripping or phlebectomy (removing surface veins). Your doctor will discuss options.

Living with this condition

Living with a leg ulcer can be frustrating because it takes time to heal. You will need to visit a nurse regularly for dressing changes. It is important to follow your care plan and keep your leg raised when resting.

Lifestyle tips

• Do gentle exercises like walking or ankle pumps to improve blood flow
• Avoid sitting or standing for long periods — move around every hour
• Do not cross your legs when sitting
• Wear loose-fitting clothes that do not restrict your legs

Diet and exercise

Eat a balanced diet rich in protein (eggs, fish, beans) and vitamins C and E (fruits, vegetables). Drink plenty of water. Exercise regularly, but avoid high-impact activities that could injure your leg.

Mental health and emotional wellbeing

Having a chronic wound can affect your mood and make you feel down. It is normal to feel frustrated or worried. Talk to your doctor or nurse about how you are feeling. They can connect you with support.

Prevention

You can reduce the chance of getting a leg ulcer by wearing compression stockings if you have varicose veins or a history of blood clots. Stay active, maintain a healthy weight, and avoid long periods of standing or sitting.

Complications

If left untreated

• The ulcer may get larger and deeper
• Infection of the skin and bone (cellulitis or osteomyelitis)
• Permanent scarring and skin changes
• In rare cases, the ulcer can turn into skin cancer (squamous cell carcinoma)

Long-term outlook

With proper care, most venous leg ulcers heal within a few months. However, they can come back. Staying on top of treatment and making lifestyle changes can greatly reduce the risk of recurrence.

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