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Venous leg ulcers

Venous leg ulcers are one of the most common type of wounds occurring in the lower limb, developing mostly along the inside of the lower leg, below the knee.

A venous ulcer occurs when swelling, due to damaged valves of the lower leg veins, is uncontrolled. This can cause blood to pool in the ankles and fluid to leak into the surrounding tissue. This fluid breaks down the tissue and an ulcer forms. Venous ulcers can be quite painful.

Numerous disorders can contribute to the damage of your veins, including deep vein thrombosis (DVT), phlebitis, congestive heart failure, obesity, multiple pregnancies and muscle weakness secondary to paralysis or arthritis.

Any two of the following will increase your risk of developing a venous ulcer:

  • Obesity.
  • Immobility.
  • Age over 60 years old.
  • Varicose veins.
  • History of phlebitis or DVT.
  • Malnutrition.

Symptoms

You may be at risk for a venous ulcer if you have one or more of the following signs:

  • Swollen ankles (the most common symptom).
  • Heavy or aching feeling in your legs when you stand or sit for long periods of time.
  • Red spots or brownish discoloration on the skin around your ankles.
  • Skin over your legs becomes leathery, dry or scaly.

Once you develop an ulcer, they are generally slow to heal and often come back if you don't take steps to prevent them.

Treatment and care

After a thorough evaluation, which may include diagnostic testing, your physician will discuss a treatment plan with you. Treatments vary based on individuals, but may include:

  • Special dressings to absorb drainage.
  • Compression stockings or a special pump to reduce swelling.
  • Proper elevation to eliminate swelling and allow optimum circulation.
  • Hyperbaric oxygen therapy (HBO).

Regular exercise, such as walking, will help improve your circulation, but before beginning a walking program, talk to you doctor.

Your physician will also encourage you to eat healthy. Foods high in protein, vitamins and minerals are important to healing and maintaining healthy skin.

Although vein problems seldom go away completely, the good news is early intervention, proper treatment and a multi- disciplinary team approach increases your chances of healing.

Your compliance with the plan of care is the single most important factor in your healing!

Care measures to improve circulation and control swelling

  • Elevate your legs often at the level of your heart.
  • Don't stand or sit with your legs down for more than an hour.
  • Examine your legs carefully each day and observe for skin changes.
  • Exercise your ankles while in bed (draw letters of alphabet with toes).
  • Wear your compression stockings as directed by your physician. Put them on every morning to prevent swelling. Do not wear after your legs become swollen—you can cause harm if they become too tight (elevate your legs until swelling is reduced).
  • If you are overweight, lose those extra pounds (under a physician's direction).
  • Place six inch blocks under the legs at the foot of your bed to elevate your legs to the level of your heart.
  • Use skin cream on your legs to keep the skin soft and prevent cracking. Some people find the following an easy way to remember the basics:

The three "E"s to control swelling

Exercise: To increase blood flow back to the heart to promote better circulation.

Elevation: To increase blood flow to the heart. Legs should be above the heart.

Elastic compression: To squeeze the leg veins, which helps prevent blood from flowing backwards.

With proper self-care, most symptoms can be reduced and leg ulcers minimized. Early recognition of an ulcer and immediate care under your physician's direction can prevent complications.

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