Venous leg ulcer

A leg ulcer is a long-lasting (chronic) sore. They usually develop on the inside of the leg, just above the ankle.

Symptoms of a venous leg ulcer

Venous leg ulcers are open, often painful, sores in the skin that take more than a month to heal. Skin changes can vary on different skin colours.

If you have a venous leg ulcer, you may also have:

• swollen ankles (oedema)
• discolouration and darkening of the skin around the ulcer
• hardened skin around the ulcer
• a heavy feeling in your legs
• aching or swelling in your legs
• red, flaky, scaly and itchy skin on your legs (varicose eczema)
• swollen and enlarged veins on your legs (varicose vein)

A venous leg ulcer can be prone to bacterial infection.

Symptoms of an infected leg ulcer can include:

• worsening pain
• a green or unpleasant discharge coming from the ulcer
• a high temperature (fever)

Diagnosing venous leg ulcers

Speak to your GP practice if you think you have a venous leg ulcer. The ulcer is unlikely to heal without specialist treatment.

They will discuss your symptoms and examine the affected leg to help diagnose a venous leg ulcer. However, they may also need to do some other tests.

Medical history and examination

Your GP or practice nurse will ask whether you have any other symptoms associated with venous leg ulcers, including:

• swelling in your ankles
• discoloured or hard skin

They’ll try to work out the cause of the ulcer by asking about underlying conditions or previous injuries, such as: diabetes, deep vein thrombosis (DVT), injury or surgery in the affected leg, a previous leg ulcer

They’ll also examine your leg when you’re standing up and lying down.

They’ll also feel your pulse at your ankles to make sure the arteries in your leg are working properly.

Doppler study

You GP or nurse will carry out a test called the Doppler study. This helps to rule out peripheral arterial disease (a condition affecting the arteries).

This involves measuring the blood pressure in the arteries at your ankles and comparing it to the pressure in your arms. If you have peripheral arterial disease, the blood pressure in your ankles will be lower than your arms.

It’s important to carry out this check as the main treatment for venous ulcers is compression bandages or stockings. This improves the vein circulation in your legs. It’s not safe to apply compression if the ankle artery pressures are low.

Referral to a specialist

In some cases, your GP or nurse may decide to refer you to a specialist in conditions affecting the blood vessels (vascular specialist).

For example, you may be referred to a vascular specialist if your GP or nurse is unsure about your diagnosis, or if they suspect your ulcer may be caused by:

• artery diseases
• diabetes
• rheumatoid arthritis

The specialist will discuss your medical history and examine you. They may also need to arrange further investigations to plan your treatment.

Treatment for venous leg ulcers

Most venous leg ulcers heal within 6 months with treatment.

Cleaning and dressing the ulcer

The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This provides the best conditions for the ulcer to heal.

A simple, non-sticky dressing will be used to dress your ulcer. This usually needs to be changed once a week. Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.

Compression

To improve vein circulation in your legs and treat swelling, your nurse will apply a firm compression bandage over the affected leg. These bandages are designed to squeeze your legs and encourage blood to flow upwards, towards your heart.

There are many different types of bandage or elastic stockings used to treat venous leg ulcers, which may be made in 2 to 4 different layers.

The bandage is changed once a week, when the dressing is changed.

When compression bandages are first applied to an unhealthy ulcer, it’s usually painful.

Ideally, you should have paracetamol  or an alternative painkiller prescribed by your GP. You can get paracetamol from your local pharmacist  or your GP. The pain will lessen once the ulcer starts to heal.

It’s important to wear your compression bandage exactly as instructed. If you have any problems, it’s usually best to contact your nurse, instead of trying to remove it yourself. If the compression bandage feels a little too tight and is uncomfortable in bed at night, getting up for a short walk will usually help.

However, you’ll need to cut the bandage off if:

• you get severe pain at the front of your ankle
• you get severe pain on the top of your foot
• your toes become blue and swollen

Once you remove the bandage, keep your leg elevated and contact your doctor or nurse as soon as possible.

In some clinics, specialist teams are using new alternatives to compression bandages. These include:

• special stockings
• other compressive devices

These may not be available in every clinic. Your specialist will be able to advise you whether a different approach may help you.

Treating associated symptoms

Swelling in the legs and ankles

Venous leg ulcers are often accompanied by swelling of your feet and ankles (oedema), which is caused by fluid. This can be controlled by compression bandages.

Itchy skin

Some people with venous leg ulcers develop rashes with scaly and itchy skin .

This is often due to varicose eczema , which can be treated with a moisturiser (emollient). Sometimes a mild corticosteroid cream or ointment can also help. In rare cases, you may need to be referred to a dermatologist (skin specialist) for treatment.

Itchy skin can also sometimes be caused by an allergic reaction to the dressings or creams applied by your nurse. If this happens, you may need to be tested for allergies.

It’s important to avoid scratching your legs if they feel itchy because this damages the skin and may lead to further ulcers.

Looking after yourself during treatment

Treatment for an infected ulcer

If your ulcer becomes infected, it should be cleaned and dressed as usual.

You should also elevate your leg most of the time and you’ll be prescribed a 7-day course of antibiotics .

Antibiotic treatment aims to clear the infection. However, antibiotics don’t heal ulcers and should only be used in short courses to treat infected ulcers.

What to do after a venous leg ulcer has healed

Once you’ve had a venous leg ulcer, another ulcer could develop.

The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed. Your nurse will help you find a stocking that fits correctly and that you can manage yourself.

Various accessories are available to help you put them on and take them off.

What causes a venous leg ulcer?

A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. If this happens, pressure inside the veins increases.

This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch.

Unless you have treatment to improve the circulation in your legs, the ulcer may not heal.

Who’s most at risk of a venous leg ulcer?

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

• obesity or being overweight – this increases the pressure in the leg veins
• if you have difficulty walking – this can weaken the calf muscles, which can affect circulation in the leg veins
• previous deep vein thrombosis (DVI) – blood clots that develop in the leg can damage valves in the veins
• varicose veins– swollen and enlarged veins caused by malfunctioning valves
• previous injury to the leg, such as a broken or fractured bone, which may cause DVT or affect your walking
• previous surgery to the leg, such as a hip replacement or knee or , which can prevent you from moving about
• increasing age – some people find it harder to move around as they get older, particularly if they suffer from arthritis

How to prevent venous leg ulcers

There are ways to help prevent venous leg ulcers. For example, you could:

• wear compression stockings – this may be recommended by your GP
• manage your weight – if you’re obese  or overweight, losing weight can help treat and prevent venous leg ulcers