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Venous Leg Ulcers

Causes | Symptoms | Treatment | Prevention | Diagnosing

A leg ulcer is a long-lasting (chronic) sore on the leg or foot that takes more than 4-6 weeks to heal.  They most often develop on the inner leg, just above the ankle (the gaiter area).  Venous leg ulcers are estimated to affect around 1 in 500 people, or 1% of the adult population in the Western hemisphere, although they become much more common with age.  It is estimated that 1 in 50 people over the age of 70 has one.  You are more at risk of developing one if you find it difficult to move around because of a problem such as osteoarthritis, a leg fracture, hip/knee replacement, obesity, or paralysis.  People with varicose veins also have a higher risk of developing venous leg ulcers.

Other types of leg ulcers:

  • Arterial leg ulcers – caused by poor blood circulation in the arteries
  • Diabetic leg ulcers – caused by the high blood sugar associated with diabetes
  • Vasculitic leg ulcers – associated with chronic inflammatory disorders such as rheumatoid arthritis and lupus
  • Traumatic leg ulcers – caused by injury to the leg
  • Malignant leg ulcers – caused by a tumor of the skin of the leg

CAUSES OF VENOUS LEG ULCERS

A venous leg ulcer can develop after a minor injury if there is a problem with the venous circulation of blood in your leg veins, such as when the venous pressure is increased by the retrograde flow of blood due to faulty valves in your leg veins.  This constant high pressure can damage the tiny blood vessels in your skin and make it fragile.  As a result, your skin can easily break down and form an ulcer after a bump or a scratch.  Unless you seek medical help soon to treat the underlying venous hypertension in your legs, the ulcer can take a long time to heal, sometimes months to years.

A number of factors can increase your risk of developing a venous leg ulcer, including:

  • Obesity – this increases the risk of high pressure in the leg veins
  • Varicose veins – swollen and enlarged veins caused by malfunctioning valves
  • Not being able to move for a long period of time – this can weaken the calf muscles, which can affect circulation in the leg veins
  • Previous injury to the leg – such as a broken bone, which may cause DVT
  • Previous surgery to the leg – such as hip or knee replacement, which can prevent you from moving about
  • Increasing age – as people get older, they find it more difficult to move about

SYMPTOMS OF VENOUS LEG ULCERS

The symptoms of a venous leg ulcer include:

  • Pain
  • Burning
  • Swollen ankles (edema)
  • Discoloration and darkening of the skin around the ulcer
  • Hardened skin around the ulcer, which may make your leg feel hard and resemble the shape of an upside-down champagne bottle
  • A heavy feeling in your leg
  • Red, flaky, scaly and itchy skin on your legs (varicose eczema)
  • Swollen and enlarged veins on your legs (varicose veins)
  • An unpleasant and foul-smelling discharge from the ulcer
  • Signs of infection:
    • Worsening pain
    • A green or unpleasant discharge coming from the ulcer
    • Redness and swelling of the skin around the ulcer
    • A high temperature (fever)

TREATMENT FOR VENOUS LEG ULCERS

Most venous leg ulcers will heal within three to four months, if they are treated by a healthcare professional trained in the management of chronic venous disorders, compression therapy and other procedures to treat the underlying causes.  Some ulcers may take longer to heal, and a very small number never heal.  Treatment usually involves cleaning and dressing the wound and using short-stretch (inelastic) compression bandages to improve the flow of blood in the legs.  Antibiotics may also be used if the ulcer becomes infected, but they do not help uninfected ulcers heal.  Unless the underlying cause of the ulcer is addressed, there is a high risk of a venous leg ulcer recurring after treatment.  Underlying causes could include immobility, obesity or varicose veins.

PREVENTION OF VENOUS LEG ULCERS

There are several ways to help prevent a venous leg ulcer, such as long-term use of compression stockings, losing weight if you are overweight, exercising regularly, elevating your legs when possible and treating your varicose veins.  This is particularly important if you have previously had a leg ulcer.  Once a leg has suffered a venous leg ulcer, there is a significant chance of further ulcers developing within a few months or years.

DIAGNOSING VENOUS LEG ULCERS

You will be given a physical examination, standing or lying down. You will be asked questions about whether you have any additional symptoms associated with venous leg ulcers, such as swelling of your ankles, skin discoloration, hardened skin, or history of prior skin infection.  Your pulses will be checked, to make sure your arteries are working properly.  Your medical history will be taken, to inquire about underlying conditions you may have, such as diabetes, or deep vein thrombosis (DVT), and any previous injury, ulcers, or surgery you may have had in your affected leg.

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