Venous leg ulcers are common. The most important part of treatment is for compression bandages to be applied correctly. Keep as active as possible but elevate your leg when you are resting. After an ulcer has healed you should wear a support stocking each day which helps to prevent it recurring.
What is a venous leg ulcer?
Venous leg ulcers mainly occur just above the ankle. They usually affect older people and are more common in women. Venous leg ulcers can be painless but some are painful. Without treatment, an ulcer may become larger and cause problems in the leg. Skin inflammation (dermatitis) sometimes develops around a venous ulcer.
What causes venous leg ulcers?
The root of the problem is increased pressure of blood in the veins of the lower leg. This causes fluid to ooze out of the veins beneath the skin. This causes swelling, thickening and damage to the skin. The damaged skin may eventually break down to form an ulcer.
The increased pressure of blood in the leg veins is due to blood collecting in the smaller veins next to the skin. The blood tends to collect and pool because the valves in the larger veins become damaged by a previous blood clot (thrombosis) in the vein,or varicose veins. Gravity causes blood to flow back through the damaged valves and pool in the lower veins.
How is a venous leg ulcer diagnosed?
The appearance of a venous leg ulcer is usually fairly typical. It often looks different to ulcers caused by other problems such as poor circulation or nerve problems.
Venous leg ulcers mainly occur just above the ankle. They usually affect older people and are more common in women. Venous leg ulcers can be painless but some are painful. Without treatment, an ulcer may become larger and cause problems in the leg. Skin inflammation (dermatitis) sometimes develops around a venous ulcer.
What is the treatment for venous leg ulcers?
The ulcer is dressed in a similar way to any other wound. However, an ulcer is unlikely to heal with just dressings. In addition to a dressing, the following treatments help the ulcer to heal.
Compression Bandaging
This is the most important part of treatment. The aim is to counteract the raised pressure in the leg veins. This gives the best chance for the ulcer to heal. The common method is 2-4 layers of bandages over the dressing. When the bandages are put on, the pressure is put highest at the ankle and gradually less towards the knee and thigh. (A support (compression) stocking over the dressing is sometimes used as an alternative but not thought to be as good as bandaging.)
The bandages are reapplied every week or so. It is best to put the bandages on after you have raised (elevated) the leg for several hours or overnight (see below). So, make extra effort to keep your leg elevated just before the nurse is due to see you.
A note of caution: when you have a compression bandage on you should still be able to move your ankle around. Occasionally, the compression is too tight, or it may affect the circulation in the legs. Therefore, take off the bandages if your foot changes colour or temperature, or if you have increasing pain. Then see your doctor or nurse for advice.
Elevation and Activity
When you are resting, if possible, try to keep your leg raised higher than your hip. This is particularly important if your leg is swollen. The aim is to let gravity help to pull fluid and blood in the right direction – towards the heart. This reduces swelling in the leg and reduces the pressure of blood in the leg veins. Try to set 3 or 4 periods per day of about 30 minutes to lie down with your leg raised. For example, lie on a bed or sofa with your foot on a couple of pillows. However, do not spend all your time in bed or resting. For the rest of the time, keep as active as you can and do normal activities. If possible, regular walks are good but do not stand still for long periods.
When you sleep overnight, if possible, try to keep your leg raised. You can do this by putting some pillows under the bottom of the mattress. (It may not be possible to sleep like this if you have certain other medical problems or disabilities.)
Other Treatments
In some people, other conditions such as anaemia, poor nutrition, swelling of the legs and other medical problems may mean that the skin has less chance of healing well. Other treatments may be needed to help heal a venous leg ulcer. For example:
- Try to stop smoking if you are a smoker. The chemicals in cigarettes may interfere with the skin healing.
- Antibiotic medicines are sometimes advised for short periods if the skin and tissues around the ulcer become infected.
- Skin care. The skin around an ulcer is often inflamed or scaly. Your doctor or nurse may advise on a cream to reduce inflammation if necessary.
- Dietary advice if your diet is not very good. Also, if you are overweight then losing some weightmay help. Obesity is a risk factor for developing venous leg ulcers.
- Pentoxifylline improves blood circulation and you may be offered this medicine to promote healing of the ulcer.
- Debridement is essential treatment of ulcer and described separately.
- Surgery for varicose veins or other vein problems is advised in some cases. This may correct back pressure of blood pooling in the veins and allow an ulcer to heal. Venous surgery is considered an adjunct treatment and should be considered after patient has been receiving compression therapy.
- A leg ulcer is much less likely to recur if you wear compression stockings regularly.
