What are Venous Leg Ulcers?
Important Questions Answered
What is a venous leg ulcer?
A venous leg ulcer is defined as a break in the skin of the leg that takes more than 4 to 6 weeks to heal. [1]
Venous leg ulcers occur because of underlying chronic venous insufficiency (CVI).[2]
This is a condition in which poor circulation significantly increases the pressure on the venous system. Continuous high pressure in the veins can lead to damage to the blood vessels in the skin. This damage makes the skin more fragile and susceptible to breaking after minor injuries such as a small scratch or shearing force.[3]
Most leg ulcers, except for those caused by direct trauma or minor injury, can take months, if not years, to develop into a wound. They are most common on the inside of the leg, just above the ankle.
It can be a long-term and recurring condition that causes discomfort, pain, infection, reduced mobility, malodour, isolation, and emotional distress.
Venous leg ulcers are the most common type of leg ulcer, accounting for more than 60% of all cases.[4]
How many people are affected by leg ulcers?
In the UK, figures reveal that around 1 in 500 people will be affected by venous leg ulcers. The risk of developing venous leg ulcers only increases as we age. The latest statistics show that around 1 in 50 people over the age of 80 has a leg ulcer.[5]
What are the signs of a venous leg ulcer?
Venous leg ulcers present as open wounds on the lower limbs. Their appearance and severity will vary depending on how long you have had the ulcer and your general health. There are some other signs that are indicative of a venous leg ulcer:
• Aching or a feeling of heaviness in the lower limbs
• Swollen ankles
• Varicose veins
• Discolouration in the area around the ulcer
• Itchiness
• Changes to skin (i.e., hardened or tauter)
• Fluid and slough weeping from the wound edges
What are the risk factors for venous leg ulcers?
There are several health and lifestyle factors that can increase your risk of developing a venous leg ulcer[6]:
• Age
• Family history of venous leg ulcers
• Chronic Venous Insufficiency (CVI)
• Obesity
• Mobility issues
• Varicose veins
• Deep Vein Thrombosis (DVT)
• Smoking
• Previous injuries in the hip or leg region
• High cholesterol
• High blood pressure
What is the treatment for venous leg ulcers?
Effective venous leg ulcer management is a combination of several key practices. The most important practice is compression therapy.
Some other key aspects of venous leg ulcer management:
• Cleansing and debridement
• Limb elevation
• Exercise
• Caring for the skin
• Systemic therapies (i.e., antibiotics)
How does compression therapy work?
Compression therapy is the cornerstone of treatment for venous leg ulcers. Compression therapy is intended to halt the force of gravity and promote normal blood flow up the leg and back up to the heart. [9]
The treatment involves the use of compression stockings and bandages that squeeze the affected limb to improve circulation.
Compression therapy can be uncomfortable to begin with, but any initial discomfort should subside once the swelling goes down.
Compression therapy should not, however, cause you any unmanageable levels of pain. If you are experiencing severe pain, it is important that you contact your clinician as soon as possible.
Compression bandaging should only be applied and removed by a healthcare professional.
Why is elevation important?
Elevating your legs above the heart will encourage the blood to return to the heart and alleviate some of the excess venous pressure in the limbs. Elevating your limbs whenever you are sitting or lying down will help promote normal blood flow.[10]
Elevation can be performed in various ways. This can be done by resting your legs on the arms of your sofa or by putting firm pillows at the end of your bed to keep your feet elevated above your head.
Your clinician will advise you on how much time you should spend with your limbs in an elevated position each day.
Can exercise help to treat venous leg ulcers?
Light exercise is a great way of improving circulation and reducing swelling in the affected limb. Exercise can accelerate the wound healing process and prevent the development of another venous leg ulcer in the future.[11]
Your mobile capabilities will dictate the types of exercises you are able to perform, and you should seek clinical advice on which activities are the best suited for you.
How do I know if my venous leg ulcer is infected?
It is critical to notify your clinician of any signs of infection. This is because infection can lead to an increase in pain and discomfort as well as a range of more serious complications.
There are a few signs and symptoms indicating that your venous leg ulcer has become infected:
• Sudden development of extremely red skin around the ulcer
• Noticeable increase in pain and discomfort
• Nausea
• A high temperature
• The skin around the ulcer feels warm
• The ulcer produces large amounts of foul-smelling discharge
The best method of preventing infection is to ensure the leg ulcer is clean and appropriately bandaged.
Why is my venous leg ulcer not healing?
With appropriate treatment, a venous leg ulcer should start to show the first signs of healing within a few weeks. However, there are several reasons why your leg ulcer may not be healing as expected.
Wounds on the lower limbs generally take longer to heal than wounds on other parts of the body. This is, in part, because this area is one of the most affected by circulation issues due to its distance from the heart. This plays a role in delayed wound healing.
You may also be experiencing delayed wound healing if you are carrying excess weight.
Requiring changes to your treatment plan or compression therapy adjustments may also be contributing factors.
How do I reduce the risk of venous leg ulcers?
The best way to minimise the risk of developing a leg ulcer is to reduce venous pressure.
• Wear compression bandages or stockings, following your clinician’s guidance.
• Keep as active as you possibly can. If you have mobility issues, your clinician may be able to instruct you on some light exercises that can improve circulation.
• Maintain a balanced diet and get enough sleep.
• Manage your blood pressure and cholesterol levels to reduce the stress on your venous system.
• Quit smoking.
How can I care for my legs after my ulcer has healed?
The most effective preventative measure you can take is to wear your compression hosiery and bandages consistently. Your clinician should advise you on what size and strength of bandage is best suited for you.
References:
- Dyble, Tina. Venous Leg Ulceration. NHS.UK, September 2021, DM 1 Venous Leg Ulceration (jpaget.nhs.uk)
- Ibid
- Nelzen O, Bergqvist D, Lindhagen A. Venous and Non-Venous Leg Ulcers: Clinical History and Appearance in a Population Study. Br J Surg 1994; 81: 182-7
- Overview: Venous Leg Ulcer, 16 November, 2022, NHS.UK Venous leg ulcer – NHS (www.nhs.uk)
- Ibid
- Ibid
- Whayman, Nicola. Doppler Assessment: Getting it Right. Wound Essentials 2014; 9(2): 48-9
- Ibid: 51
- Berszakiewicz, Andrzej et al., Compression Therapy in Venous Diseases: Physical Assumptions and Clinical effects. Postepy Dermatol Alergol 2020; 37(6): 842-4
- Chatterjee, Sasanka. Venous Ulcers of the Lower Limb: Where do we Stand?. Indian J Plast Surg 2012; 45(2): 266-274
- Jull, Andrew. Prescribed Exercise with Compression vs Compression Alone in Treating Patients with Venous Leg Ulcers. JAMA Dermatol 2018; 154 (11): 1304-1311
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Disclaimer:
Please note that while every effort is made to ensure the accuracy of the content presented, it is purely for educational purposes only and is not a substitute for professional medical advice.