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Venous Leg Ulcers: Risk Factors, Treatment and Prevention

Venous leg ulcers are ulcers that occur on the lower leg. An ulcer is a type of sore on the skin that does not heal on its own in the way a cut usually does. Venous leg ulcers, being the most common type of leg ulcer, are a common problem among older adults. In many people, the veins of the legs become damaged over the time as a result of poor blood circulation and increased blood pressure and start leaking. This eventually causes damage to the surrounding skin and makes venous leg ulcers more likely.

Tight bandages, known as compression bandages, are the first line of treatment and for most patients this heals the ulcers completely. They are wrapped around the ulcers and work by helping blood flow back up the legs while preventing further pooling of blood and leakage. Once the ulcers have healed, compression stockings (not bandages!) are usually worn to prevent them from coming back.

Symptoms of Venous Leg Ulcers

The signs and symptoms of venous leg ulcers include:

  • A dark or patchy colour on the skin of the ankle or calf
  • Swelling of the ankles
  • Itchy skin with a scaly red rash surrounding the ulcer
  • A leakage of fluid from the ulcer

If venous leg ulcers are left untreated, they can become infected. Signs of infection include:

  • Redness of surrounding skin
  • Increased pain
  • An increase in the amount of fluid oozing from the ulcer
  • An unpleasant, embarrassing smell

Causes and Risk Factors for Venous Leg Ulcers

Venous leg ulcers develop from tiny injuries when there is poor blood circulation and increased blood pressure in the veins of the lower leg. The veins in the legs contain valves to stop blood flowing backwards and, if these valves stop working properly, the blood will flow back and cause a build-up of blood in a small area in the lower leg. This creates constant pressure in the leg veins, which damages the walls of the tiny veins called capillaries and causes leakage. In turn, this leakage causes swelling and damage to the skin, which eventually lead to ulcers developing on the skin.

The main risk factors for venous ulcers include old age, genetic predisposition, smoking, having an occupation that involves a lot of standing, difficulty walking, varicose veins, excess weight, high blood pressure, deep vein thrombosis, venous insufficiency, diabetes, rheumatoid arthritis, previous injury or surgery to the leg, and circulatory disorders such as peripheral vascular disease.

Treatments for Venous Leg Ulcers

The following treatments may be used for venous leg ulcers:

Compression Bandages

The main and by far the most effective treatment for venous leg ulcers are tight compression bandages. They are wrapped around the ulcers and work by helping the static blood near the surface of the leg flow back up the legs and by preventing further pooling of blood and leakage. However, the dressing takes a long time to put on and it can sometimes be uncomfortable and awkward to wear.

Sometimes, compression bandages cannot be used in patients with poor arterial blood circulation. The arteries carry blood away from the heart to all parts of the body and, if the circulation is poor (as a result of arterial disease), there will be an inadequate supply of fresh blood to the leg. Arterial insufficiency ulcers can be often treated surgically by bypassing the blockage in the artery. However, venous leg ulcers in patients with arterial disease that is not suitable for such surgery are difficult to treat because compression cannot be applied.

Compression Stockings

Compression stockings work in the same way as bandages, although they apply less pressure. They are used to keep the leg healthy once it has healed with the help of compression bandages. Compression stockings are not used when an ulcer is present as it would be difficult and painful to try to pull them up over an ulcer. Likewise, they are not suitable for oozing leg ulcers as these will stick to the stockings. Special applicators for compression stockings are available for people who find it difficult to put on the stockings and their caregivers.

Skin Grafting

Skin grafting is sometimes used to treat large venous ulcers that are difficult to heal. A piece of skin is taken from the thigh and applied to the area with the ulcers. Compression is needed after the surgery to prevent the ulcer from returning.

Treatment of Associated Symptoms

The following treatments may be used to treat the symptoms of conditions associated with venous ulcers:

  • Antibiotics and antiseptics. Venous leg ulcers can sometimes become infected. Signs of infection include redness of surrounding skin, increased pain, and unpleasant smell or an increase in the amount of fluid oozing from the ulcer. Infections are treated with antiseptics or antibiotics applied to the skin, or in more severe cases, with oral antibiotics.
  • Painkillers. These are used to relieve the pain associated with particularly painful ulcers.
  • Pentoxifylline. This drug, which is normally used to treat muscle pain associated with peripheral artery disease, can be prescribed to improve blood circulation and promote healing of venous ulcers.
  • Aspirin. It has been shown to promote the healing of leg ulcers and reduce their size. In addition, aspirin can also help relieve pain, reduce inflammation and prevent blood clots that damage the valves in the veins.
  • Iron supplements. They are sometimes recommended to patients with venous leg ulcers who are anemic.
  • Surgery for varicose veins. It helps lower the risk of developing venous ulcers by preventing the blood pooling in the lower legs.

How to Prevent Venous Leg Ulcers

Although it is not always possible to prevent venous leg ulcers, there are a number of things people can do to help ease their symptoms. They should:

  • Stop smoking because there is a strong link between smoking and venous leg ulcers
  • Avoid standing still whenever possible as this causes blood to collect in the veins
  • Put their feet up while sitting down, e.g., by using a footstool
  • Wear support stockings, which are useful for people with varicose veins or whose job involves a lot of standing
  • Do some exercise. For example, a daily walk is a good idea because walking or simply flexing the calf muscles helps the blood circulate properly. Venous ulcers are less likely to develop in people who exercise regularly.
  • Losing weight may be useful as venous leg ulcers are more common in overweight people

Where to Find Further Info and Help: Circulation Foundation