A venous leg ulcer is an open sore, usually near the ankle, caused by leg veins that don’t move blood back to the heart well. It heals slowly and often returns, but treating the vein problem may help.
An infected leg wound needs prompt care. MedlinePlus and the American Academy of Family Physicians (AAFP) list signs of infection to report to a provider promptly, including spreading redness, warmth or swelling around an ulcer, cloudy or yellowish drainage, a bad smell, more pain, and fever or chills. If you have diabetes, take any foot or leg sore seriously: nerve damage can keep you from feeling a wound as it gets worse, MedlinePlus explains.
In the video above, vein specialist Dr. Peter Morgan explains how he treats leg wounds caused by chronic venous insufficiency (CVI), a long-term problem with the leg veins. A patient describes ulcers near his ankles that took months to heal, with a new one appearing as another closed.
What Dr. Morgan says
Dr. Morgan says some wounds have other causes, but most chronic wounds that won’t heal are related to vein problems.
In the patient’s case, he explains, an ultrasound showed severe CVI with very large varicose veins and swelling. His team carefully mapped which leg veins were working and which were “running backwards,” then closed (ablated) only the faulty ones. Restoring normal blood flow out of the leg, he says, improves the health of the leg and helps wounds heal. The patient says better circulation lets him work and stay on his feet longer, without the foot pain he had before. One person’s experience doesn’t predict anyone else’s results.
In another video, Non Healing Wounds, Dr. Morgan describes a very unusual, severe case in which his team set out to close all the veins with backward flow.
How vein disease causes ulcers
Valves inside the leg veins work like one-way doors, keeping blood flowing up toward the heart. When the valves weaken, or a vein is scarred or blocked, blood flows backward and pools in the lower leg, MedlinePlus explains. The higher pressure and extra fluid starve the skin of oxygen and nutrients, so the tissue breaks down and an open wound forms. A past blood clot in a deep leg vein is the most common cause of CVI, Cleveland Clinic notes.
The AAFP calls venous ulcers the most common type of long-lasting leg ulcer, affecting about 1% to 3% of people in the U.S.
How they differ from other wounds
According to the AAFP:
- Venous ulcers are usually shallow, with irregular edges, and often drain fluid. They tend to form around the inner ankle, and leg swelling often worsens through the day and improves when the legs are raised.
- Arterial ulcers, caused by poor blood flow through the arteries, are usually deeper, on the front of the leg, the top of the foot or the toes. The base looks dry, and the foot may feel cold.
- Diabetic ulcers usually form on the bottom of the foot over bony spots, often ringed by callus. MedlinePlus notes they are often painless.
The difference matters: compression, the main treatment for venous ulcers, can harm a leg that doesn’t get enough blood through its arteries.
Who is at risk
MedlinePlus, Cleveland Clinic and the AAFP list varicose veins, a past leg blood clot, a family history of vein problems, older age, being female, obesity, pregnancy, smoking, inactivity, long hours of sitting or standing, a serious leg injury or surgery, and a previous venous ulcer.
Warning signs before an ulcer forms
MedlinePlus lists leg swelling, heaviness and cramping; itching or tingling; and skin that turns dark red, purple or brown and hardens. Cleveland Clinic adds flaky or leathery-looking skin and swelling that is worse after standing. It explains that on the scale doctors use to grade vein disease, changes in skin color or texture come just before the ulcer stages. The first sign of an ulcer itself is a lower-leg wound that hasn’t healed after about two weeks.
How they’re diagnosed
A provider examines your legs and the wound. Tests can include:
- a duplex ultrasound, which shows blood flow and damaged vein segments, according to the Society for Vascular Surgery (SVS) and Cleveland Clinic
- an ankle-brachial index (ABI), which checks blood flow in the legs; the AAFP says arterial blood flow should be checked before compression starts
- a biopsy if healing stalls or the wound looks unusual
Treatment
Professional wound care. Cleveland Clinic describes removing dead tissue in the office (debridement), cleaning the wound and changing dressings regularly, with antibiotics if there is infection. At home, follow your provider’s instructions for cleaning and redressing the wound, MedlinePlus advises.
Compression. The AAFP calls compression bandages or stockings the standard treatment for people without significant artery disease. MedlinePlus says compression reduces pooling, swelling and pain.
Elevation and walking. MedlinePlus advises raising your feet above heart level as often as you can and walking or exercising daily.
Treating the vein problem. Endovenous ablation, which uses heat to seal a faulty vein, and sclerotherapy can close damaged veins, Cleveland Clinic and the SVS explain. In recent trials, the AAFP reports, treating backward flow in the surface veins early, along with compression, helped ulcers heal faster than compression alone or a delayed procedure. Cleveland Clinic notes that CVI can’t be cured and that ulcers can take months or years to heal.
When to get care right away
Get care right away for the infection signs at the top of this article. Cleveland Clinic warns that leg ulcers can lead to cellulitis, a serious skin infection, and to bone infection or sepsis, which can be life-threatening. If you have diabetes, MedlinePlus advises calling your provider if an ulcer looks very white, blue or black.
Preventing ulcers from coming back
The AAFP notes that up to 70% of venous ulcers have been reported to come back. Treating the vein problem, long-term compression stockings, raising the legs and calf exercises may help lower that risk. MedlinePlus also suggests checking your legs and feet daily for cracks or color changes, moisturizing the skin, not smoking, controlling blood sugar if you have diabetes, staying active and keeping a healthy weight.
Questions to ask your doctor
- Is this wound caused by vein disease, artery disease, diabetes or something else?
- Do I need an ultrasound or an ankle-brachial index?
- Is compression safe for me, and how should I wear it?
- Would a vein procedure help my ulcer heal or keep it from returning?
- Which signs mean I should call you right away?
- How can I lower my chance of another ulcer?
Dr. Morgan is a vein specialist in the Houston area. See Dr. Morgan’s Best Docs Network profile for more about the practice.
Sources
- Cleveland Clinic. Leg Ulcers.
- Cleveland Clinic. Chronic Venous Insufficiency (CVI).
- Society for Vascular Surgery. Chronic Venous Insufficiency.
- American Academy of Family Physicians, American Family Physician. Bonkemeyer Millan S, Gan R, Townsend PE. Venous Ulcers: Diagnosis and Treatment. 2019.
- MedlinePlus (U.S. National Library of Medicine). Venous ulcers - self-care.
- MedlinePlus (U.S. National Library of Medicine). Diabetes - foot ulcers.
This article is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
