Venous leg ulcer

Venous leg ulcer - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Venous leg ulcer Venous leg ulcer About venous leg ulcers Symptoms of venous leg ulcers Causes of venous leg ulcers Diagnosing venous leg ulcers Treating venous leg ulcers Preventing venous leg ulcers About venous leg ulcers A leg ulcer is a long-lasting (chronic) sore that takes more than 4to 6weeks to heal. They usually develop on the inside of the leg, just above the ankle. The symptoms of a venous leg ulcer include pain, itching and swelling in the affected leg. There may also be discoloured or hardened skin around the ulcer, and the sore may produce a foul-smelling discharge. See your GP if you think you have a leg ulcer, as it will need specialist treatment to help it heal. Your GP will examine your leg and may carry out additional tests to rule out other conditions. Read more about how a venous leg ulcer is diagnosed . What causes venous leg ulcers? A venous leg ulcer is the most common type of leg ulcer, accounting for over 90% of all cases. Venous leg ulcers can develop after a minor injury, where persistently high pressure in the veins of the legs has damaged the skin. Read more about the causes of venous leg ulcers . Whos affected? Venous leg ulcers are estimated to affect around 1 in 500 people in the UK, although they become much more common with age. Its estimated that around 1 in 50 people over the age of 80 has one. Youre more at risk of developing one if youve previously had deep vein thrombosis (DVT) orfind it difficult towalk because of a problem such as: osteoarthritis a leg injury obesity paralysis Youre also more at risk ifyouve recently had an operation on your leg, such as a hip replacement or knee replacement . People with varicose veins (swollen and enlarged veins) also have a higher risk of developing venous leg ulcers. How venous leg ulcers are treated Most venous leg ulcers heal within 3to 4months if theyre treated by a healthcare professional trained in compression therapy for leg ulcers. However, some ulcers may take longer to heal, and a very small number never heal. Treatment usually involves: cleaning and dressing the wound using compression, such as bandages or stockings, to improve the flow of blood in the legs Antibiotics may also be used if the ulcer becomes infected, but they dont help ulcers to heal. However, unless the underlying cause of the ulcer is addressed, theres a high risk of a venous leg ulcer recurring after treatment. Underlying causes could include immobility, obesity, previous DVT, or varicose veins. Read more about treating venous leg ulcers . Can venous leg ulcers be prevented? There are several ways to help prevent a venous leg ulcer in people at risk, such as: wearing compression stockings losing weight if youre overweight exercising regularly elevating your leg when possible This is particularly important if youve previously had a leg ulcer  once a leg has suffered a venous ulcer, youre at risk of further ulcers developing within months or years. Read more about preventing venous leg ulcers . Symptoms of venous leg ulcers Venous leg ulcers are open, often painful, sores in the skin that take more than a month to heal. They usually develop on the inside of the leg, just above the ankle. 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, which may make your leg feel hard or evenresemble the shape of an upside-down champagne bottle 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 veins ) an unpleasant and foul-smelling discharge from the ulcer Signs of an infection A venous leg ulcer can be susceptible to bacterial infection. Symptoms of an infected leg ulcer can include: worsening pain a green or unpleasant discharge coming from the ulcer redness and swelling of the skin around the ulcer a high temperature (fever) When to seek medical advice Contact your GP if you think youve developed a venous leg ulcer. Theyre unlikely to get better on their own, as they usually require specialist medical treatment. You should also contact your GP or leg ulcer specialist if youve been diagnosed with a venous leg ulcer and have symptoms that suggest it could be infected. Read more about how venous leg ulcers are treated . Causes of venous leg ulcers A venous leg ulcer can develop after a minor injury if theres 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 ulcermay notheal. Read more about treating venous leg ulcers . Whos most at risk? Anumber of 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 (DVT) blood clots that develop in the leg can damage valves inthe 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 impair walking previous surgery to the leg, such as a hip replacement or knee replacement , which can prevent you from moving about increasing age  people find it harder to move around as they get older, particularly if they suffer from arthritis Diagnosing venous leg ulcers See your GP if you think you have a venous leg ulcer. The ulcer is unlikely to heal without specialist treatment. Diagnosis is largely based on your symptoms and examination of your affected leg, although additional tests may be required. Medical history and examination Your GP or practice nurse will ask whether you have any other symptoms associated with venous leg ulcers, such as: swelling in your ankles discoloured or hard skin Theyll try to determine 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 Theyll also examine your leg, both when youre standing up and lying down. Varicose veins will be more obvious when youre standing up, and it will be easier to look at the ulcer when youre lying down. Theyll also feel your pulse at your ankles to make sure the arteries in your leg are working properly. Doppler study To rule outperipheral arterial disease(acondition affecting the arteries) as apossible cause of your symptoms, your GP or nurse will carry out a test known as a Doppler study. This involves measuring the blood pressure in the arteries at your ankles and comparing itto the pressure in your arms.If you have peripheral arterial disease, the blood pressure in your ankles will be lower than your arms. Its important to carry out this check as the main treatment for venous ulcers is compression bandages or stockings to improve thevein circulation in your legs. Its not safe to apply compression if the ankle artery pressures are low. Read more about how venous leg ulcers are treated . Referral to a specialist In some cases, your GP or nurse may decide to refer you toa 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, diabetesor rheumatoid arthritis . After taking your medical history and examining you, the vascular specialist may need to arrange further investigations to plan your treatment. Treating venous leg ulcers With appropriate treatment, most venous leg ulcers heal within 3to 4months. Treatment should always be carried out by a healthcare professional trained in compression therapy for leg ulcers. Usually, this will be a practice or district nurse. 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 bandageor elastic stockings used to treat venous leg ulcers, whichmay be madein 2, 3or 4different layers. The application of a compression bandage is a skilled procedure and they should only be applied by trained healthcare staff. The bandage is changed once a week, when the dressing is changed. When compression bandages are first applied to an unhealthy ulcer, its usually painful.Ideally, you should have paracetamol or an alternative painkiller prescribed by your GP.The pain will lessen once the ulcer starts to heal, but this can take up to 10-12 days. Its important to wear your compression bandage exactly as instructed. If you have any problems, its 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,youll 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,make sure you keep your leg highly elevated and contact your doctor or nurse as soon as possible. In some clinics, specialist teams are using new alternatives to compression bandages, such as special stockings or other compressive devices. These may not be available in every clinic butcould change the way ulcers are treated in future. 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. Keeping your leg elevated whenever possible, ideally with your toes at the same level as your eyes, will also help ease swelling. You should put a suitcase, sofa cushion or foam wedge under the bottom of your mattress, to help keep your legs raised while you sleep. You should also keep as active as possible and aim to continue with your normal activities. Regular exercise, such as a daily walk, will help reduce leg swelling. However, you should avoid standing or sitting still with your feet down. You should elevate your feet at least every hour. Itchy skin Some people with venous leg ulcers develop rashes with scaly and itchy skin. This isoften due to varicose eczema , which can be treated with a moisturiser (emollient) and occasionally a mild corticosteroid cream or ointment. Inrare 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. Its important to avoid scratching your legs if they feel itchy, because this damages the skin and may lead to further ulcers. Looking after yourself duringtreatment To help your ulcer heal more quickly, follow the advice below: Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse Whenever youre sitting or lying down, keep your affected leg elevated  withyourtoes level with your eyes Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation If youre overweight, try to reduce your weight witha healthy diet and regular exercise Stop smoking Moderate your alcohol consumption Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear You may also find it helpful to attend a local healthy leg club, such as those provided by the Lindsay Leg Club Foundation , for support and advice. Treating an infected ulcer An ulcer sometimes produces a large amount of discharge and becomes more painful. There may also be redness around the ulcer. These symptomsand feeling unwell are signs of infection. If your ulcer becomes infected, it should be cleaned and dressed as usual. You should also elevate your leg most of the time and youll be prescribed a 7-day course of antibiotics . The aim of antibiotic treatment is toclear the infection. However, antibiotics dont heal ulcers and should only be used in short courses to treatinfected ulcers. Follow-up You should visit your nurse once a week to have your dressings and compression bandages changed. Theyll also monitor the ulcer to see how well its healing. Once your ulcer is healing well, your nurse will see you less often. After the ulcer has healed Once youve had a venous leg ulcer, another ulcer could develop within months or years. The most effective method of preventing this is to wear compression stockings at all times when youre 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. Read more about preventing venous leg ulcers . Preventing venous leg ulcers You can help reduce your risk of developing a venous leg ulcer in several ways, such as wearing a compression stocking, losing weight and taking care of your skin. People most at risk of developing a venous leg ulcer are those who have previously had a leg ulcer. Compression stockings If youve previously had a venous leg ulcer, or youre at risk of developing one,treatment withcompression stockings may be recommended by your GP. These stockingsare specially designed to squeeze your legs, improving your circulation. Theyreusually tightest at the ankle and less tight further up your leg  this encourages blood to flow upwards, towards your heart. To be most effective, these stockings should be put on as soon as you get up and only taken off at night. Compression stockings are available in a variety of sizes, colours, styles and pressures. A nurse can help you find a stocking that fits correctly and that you can manage yourself. There are various accessories you can buy to help get the stockings on and off. Losing weight If youre obese or overweight, losing weight can help treat and prevent venous leg ulcers. Excess weight leads to high pressure in the veins in your legs, which can damage your skin. Venous ulcers are much more common among people who are overweight. To help you lose weight, regular exercise and a healthy, balanced diet are recommended. You should also avoid sitting or standing for long periods.Elevating your legs whenever possible can also help. Read moreabout: losing weight health and fitness healthy eating Treating underlying problems Treating severe varicose veins may help prevent leg swelling or ulcers. This may involve a procedure where a catheter (a thin, flexible tube) is inserted into the affected veins withhigh-frequency radio waves or lasers used to seal them. Alternatively, you may need surgery to repair the damage to your leg veins, or to remove the affected veins altogether. Read more about treating varicose veins . Source: NHS 24 - Opens in new browser window Last updated: 22 February 2023 How can we improve this page? 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