Leg ulcers cause pain, swelling and loss of sensation. They also lead to infection, gangrene and amputation.
Medical treatment aims to improve blood flow and help the ulcer heal. Your doctor may treat any underlying health conditions that contributed to the ulcer. They may recommend elevating your leg while sitting and wearing compression stockings. They may perform an angiogram if the ulcer is caused by blocked arteries.
Causes
Generally speaking, leg ulcers occur when the skin breaks down. Most of the time this happens from an injury, such as a knock or scrape. The problem is that the injury does not heal up and the area of breakdown increases in size over a period of weeks or months. This leads to infection and eventually the skin will break down completely exposing underlying tissue.
Venous leg ulcers are the most common type of non-healing wound and account for over two thirds of all leg ulcers. These open wounds are often found on the ankle or calf and have a yellow, fibrous covering with an irregular border. They are sometimes painful and may ooze. They will not heal unless the underlying condition is treated.
Poor blood circulation to the lower leg is a major cause of these wounds. This occurs when the veins can no longer return deoxygenated blood back to the heart from the legs and causes leg pain, swelling (edema) and eventually a breakdown of the skin. Other risk factors include long periods of time sitting or lying in one position, smoking, aging, varicose veins and a family history of diabetes.
Diabetic ulcers can be a very serious complication of the disease that require special care and attention to help them heal. In general, diabetic ulcers are harder to heal because the body cannot use sugar as a source of energy and so the skin is more likely to break down. It is also more difficult to tell if the ulcer is getting better or worse because people with diabetes may lose some sensation in their feet and so may not feel when the ulcer is getting bigger or smaller.
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Treatment is aimed at treating the underlying condition that contributed to the leg ulcer. This can include lowering blood pressure to reduce the amount of fluid in the leg, treating any varicose veins, removing or replacing the damaged section of the arterial leg (angioplasty or bypass surgery), reducing inflammation with medications (antibiotics or sclerotherapy) and using hyperbaric oxygen therapy. Also, elevating the leg above the heart when sitting and walking regularly, improving diet and avoiding smoking can help to prevent further damage.
Symptoms
If you think you have a leg ulcer, see your GP or Practice Nurse as soon as possible for an assessment. They will look at the wound, the surrounding skin and may feel for pulses in your groin, behind your knee and the bottom of your feet to check that blood supply is OK. They will also carry out a simple test called an ABPI which compares the blood pressure in your legs and arms.
The aim of treatment is to remove the ulcer and prevent it from recurring as well as treating the underlying cause. Your doctor will do a physical exam and ask you about your past health. You may have tests, such as an ankle-brachial index test or a venography (an ultrasound of your veins) to learn the cause of your leg ulcer.
Infection is common in leg ulcers, and if left untreated can lead to serious complications, including bone infections and severe skin infection. Your doctor will prescribe antibiotics to treat the infection. You will need to keep the wound clean and dry, changing it daily. If the ulcer is weeping or has pus, your doctor will probably give you special moist dressings to put on the wound. You may be told to raise your leg for set periods of time each day to improve circulation and help the ulcer heal.
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Venous leg ulcers are caused by weak veins that can’t move blood correctly, causing high pressure in the legs and damage to the skin. The high pressure can cause fluid and blood to pool in one part of the leg, leading to a break in the skin and an ulcer. Other causes of venous leg ulcers include varicose veins, rheumatoid arthritis and trauma to the leg.
To prevent leg ulcers, you should try to stay at a healthy weight, avoid smoking and wear comfortable, loose clothing and good shoes. You should also take regular exercise and stretch your legs. If you have a condition that increases your risk of leg ulcers, such as diabetes or vascular disease, get treated for the condition and take steps to protect your legs from injury.
Treatment
The treatment of leg ulcers is a long process, often involving specialist doctors or nurses. The first step is to identify the cause of the leg ulcer, which is often a vascular condition such as varicose veins or arterial disease. This is important because if arterial disease is the cause, treatments which are aimed at treating venous ulcers can have catastrophic effects in patients with arterial disease (critical limb ischemia and amputation).
To help determine the cause of the leg ulcer, the healthcare professional will carry out an assessment of your legs and look for evidence of wounds or damaged skin, shiny skin and brittle toenails. They will also feel for pulses in your groin, the back of your knee and your feet and compare the blood pressure in your legs and arms. This is called an ankle-brachial index (ABPI).
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In some cases, the health care provider will order a duplex ultrasound of your leg veins to look for blood clots in your deep veins or blockages in your varicose veins. This procedure uses Doppler ultrasound to evaluate blood flow in your leg veins and will help to diagnose the underlying causes of your non-healing leg ulcer. In addition, the physician may also perform a venogram and place a venous stent to improve the blood supply to the area of your non-healing leg ulcer.
Once the underlying cause of your leg ulcer has been determined, the next steps in the treatment plan will include regular dressing changes and elevating your leg above the level of your heart as much as possible to aid the healing of the wound. This is especially important when sitting and sleeping. It is recommended to raise your leg for at least a half hour at a time, three or four times a day.
The healthcare provider may also recommend exercise, weight loss and a healthy diet to reduce your risk of developing a leg ulcer. You should also avoid smoking and drinking too much alcohol as they can increase your risk of developing a leg ulcer. Finally, try to wear comfortable shoes that fit well and don’t rub your legs against anything sharp or hard.
Prevention
The main aim of treatment is to heal the ulcer and prevent it recurring as the wound heals. The type of treatment depends on what caused it – for example, a wet ulcer needs to be changed regularly (at least twice per day) while a dry ulcer may be cleaned less frequently. Treatment also includes keeping the area clean and treating any infection.
If you have severe varicose veins, treatment of this condition may help prevent leg ulcers as it can reduce the damage done to the blood vessels in the legs by swelling and thrombosis. This can include surgical ablation of superficial and/or perforating veins, or incompetent veins being blocked with solutions injected into the veins (sclerotherapy).
Once a leg ulcer develops, it is important to see your doctor and nurse as soon as possible. They will examine your ulcer and find out what’s causing it.
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A venous ulcer is caused by the abnormal backflow of blood in the legs, due to damaged one-way valves in the veins or damage from a clot or thrombosis. This causes pressure on the end of the leg which leads to a skin ulcer, often over a bony area such as the ankle. They can be very painful and are more common in older people.
The most important way to avoid getting a leg ulcer is to get plenty of exercise, and to avoid sitting or standing for long periods. Wearing compression stockings or bandages can also help to improve the flow of blood to the legs. You should try to elevate your legs for about a hour each day, by lying down with your foot propped up on a few pillows, or using a leg lift machine. It’s also a good idea to drink lots of water to prevent dehydration.
You can also help prevent leg ulcers by managing any health problems that affect blood circulation in the legs, such as diabetes or high blood pressure, and by not smoking. A diet that includes a wide range of fresh fruit and vegetables, and is low in fat, can also help to improve your general health and circulation.
