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Leg ulcers
A leg ulcer is a break in the skin that reveals the underlying flesh, usually found on the lower part of the leg or the feet.
Venous leg sores are the most common type, accounting for around 80% of leg ulcers.
Contents
Overview and definitions
Leg ulcers develop when an area of skin breaks down to reveal the underlying flesh. They mainly occur on the lower legs and feet, predominantly around the ankles, and are often very painful.
Venous leg sores, caused by venous insufficiency and hypertension, are the most common type, accounting for around 80% of leg ulcers.
It is estimated that leg ulcers affect as many as 1 in 50 older age adults.
Traditional treatment methods involve cleaning and dressing the area and applying compression bandaging. However, leg ulcers are notoriously slow to heal, so this method often has a huge impact on quality of life for the patient.
At UK Veincentre (UKVC) we first treat the underlying problem of venous insufficiency, using endovenous laser ablation (EVLA) and foam sclerotherapy, leading to quicker healing, longer-lasting results and lower recurrence rates.
Causes
Leg ulcers are caused by increased blood pressure in the legs (also known as venous hypertension).
Venous insufficiency, caused by damaged valves inside leg veins, means that blood tries to travel in the wrong direction (away from the heart), pooling in your veins and causing them to bulge and swell. This is why most patients with venous leg sores will also have varicose veins (or a history of them).
The skin of the leg is then damaged and made fragile over time by the constant high pressure, leading to complications such as eczema, skin discoloration and eventually ulceration.
Risk factors
A number of different factors can increase a person’s risk of chronic venous leg sores and ulceration, including:
- Previous leg ulcers – having a history of venous leg ulceration is one of the biggest risk factors for developing future leg ulcers. Recurrence rates are unfortunately high; estimated to be between 45-70%
- Varicose veins – individuals with varicose veins are at an increased risk of venous leg ulcers because their veins are already under high pressure
- Arterial disease – vein problems are more likely if the person already has other diseases of the arteries
- Age – the valves in the veins weaken with age and peripheral circulation becomes less efficient. This means blood is unable to flow normally through the body, which makes us more susceptible to venous insufficiency, leading to leg ulcers
- Deep vein thrombosis (DVT) – DVT is a condition that occurs when a blood clot forms in one or more of the deep veins, particularly around the legs. These clots can damage the valves in the veins and increase the chances of developing a venous leg ulcer
- Impaired mobility – being immobile for an extended period of time means the calf muscle pump mechanism is not activated through movement (e.g. walking). This makes it more difficult for the veins to transport the deoxygenated blood from your legs back up to your heart properly, causing venous insufficiency
- Surgery or injury to the lower limbs – surgical procedures such as knee or hip replacements, or significant trauma injuries, can sometimes cause valve damage in the leg veins. Recovery from surgery or injury can also include reduced mobility, which can temporarily increase pressure in the veins
- Pressure sores – bed-bound people are at risk of pressure sores, which are areas of damage to the skin caused by constant pressure or friction
- Hereditary – family history of chronic venous insufficiency is a useful indicator of venous leg ulcer risk levels
- Obesity – being overweight increases the pressure in your veins, which can increase your risk of venous insufficiency or worsen any existing symptoms
- Smoking – tobacco is known to constrict the vessels of the circulatory system, having a negative impact on the flow of blood to the legs. Studies also show that smoking can lead to delayed wound healing for existing leg ulcers
- Co-occurring conditions – other health conditions, such as diabetes and arthritis, can increase the risk of venous insufficiency
- Medication – some cardiovascular medications can contribute to leg oedema (swelling due to a build-up of fluid) and altered circulation
- Having female anatomy – venous leg ulcer rates are higher in women than in men. Hormonal changes from puberty, pregnancy, menopause, taking birth control pills or hormone replacement therapy (HRT), have all been linked to a higher risk of venous insufficiency
- Prolonged standing – standing for a long time can accelerate the backflow of blood into the legs caused by incompetent valves in the veins
Prevention
Similarly to varicose veins, it is not always possible to prevent the venous insufficiency that leads to the development of leg ulcers. However, if you believe that you are at risk of developing venous leg sores, you can make changes to your lifestyle to hopefully prevent their onset.
Getting regular exercise, eating healthily and losing excess weight can all help to improve blood flow in both arteries and veins. Stopping smoking, if you’re a smoker, will also take some of the strain off your cardiovascular system, which in turn can help your circulation.
If you do develop leg ulcers, there are some early warning signs to look out for. These include skin discoloration and pigmentation changes, or itchy and hardened skin in the lower legs. Seeking treatment as soon as possible can help to prevent leg ulcers, or at least improve recovery times.
Symptoms
Typical symptoms of venous insufficiency and hypertension, prior to the appearance of open venous leg sores, include; varicose veins, varicose eczema, swollen ankles, a feeling of heaviness in the legs, skin discoloration and pigmentation changes, itchy or hardened skin, and achy legs.
Leg ulcers themselves can vary in size and presentation, but will always include broken skin, revealing the flesh underneath. Some leg ulcers may also have a foul-smelling discharge.
Symptoms are often worsened when sitting or standing, as the leg is below the heart, amplifying the effect of venous insufficiency. Elevating the legs may help to ease symptoms, as gravity works with the body to move blood back to the heart.
Diagnosis
Leg ulcers themselves are easy to diagnose, since they are usually clearly visible open sores on the lower legs or feet.
Traditional diagnosis is mainly based on a discussion of symptoms and superficial examination of the affected area. This may done both while standing and lying down, as any visible varicose veins are usually easier to identify whilst standing up, but it is simpler to identify and take a pulse in the ankles whilst lying down.
What is not obvious from visual examination is the underlying cause of leg ulcers. It is only possible to determine if an ulcer is venous by undertaking a colour duplex ultrasound scan which shows evidence of venous insufficiency. This scan is a core part of the consultation process with UKVC.
Treatment
At UKVC, our treatment pathway for leg ulcers is similar to that for varicose veins. Leg ulcer treatment would start with a colour duplex ultrasound scan, performed during your consultation, to define the extent of the underlying cause. From that scan the best course of treatment is defined for your case, tailored specifically to your condition.
Traditional treatment methods for leg ulcers involve cleaning and dressing the area and applying compression bandaging. However, leg ulcers are notoriously slow to heal, so this method often has a huge impact on quality of life, confining the patient to wearing compression bandages for months on end.
At UKVC we believe that treating the underlying cause of venous insufficiency, with EVLA and foam sclerotherapy, produces the best long term results. In our experience, leg ulcers both heal quicker and tend to remain healed following this treatment pathway.
Once your leg ulcer heals, you will still benefit from wearing compression stockings for a short period, as they help to reduce leg swelling by helping blood flow back to the heart.
We also recommend that you try to keep your legs elevated while sitting, keeping your legs above your heart, to help blood flow out of your leg and prevent pooling. Propping your legs up on a pillow or cushion is perhaps the simplest way to achieve the appropriate elevation.
Treatment costs
We have a clear pricing structure, whether you are using health insurance, or self-funding your treatment with us. We outline the total costs involved in the diagnosis and treatment of leg ulcers, if you require EVLA and/or foam sclerotherapy.
Our prices are upfront and fixed. Consultant fees and clinic fees are included in all of our prices. Our quoted prices remain fixed for six months from the date of your initial consultation, so you can be sure our fees won’t increase during this time.
If you have health insurance, please disregard our self-funding prices.
Treatment risks
As with all medical procedures, it’s important that you weigh up the benefits of having treatment, versus the risks of side effects. You can find a full list of risks for all our vein treatments on our treatment FAQs page.
Aftercare
We would advise you to continue dressing the wound and wearing the compression stocking(s) provided by UKVC for one week following EVLA treatment. We recommend that you then continue with dressings/bandaging provided from your usual doctor until the ulcer is fully healed.
Frequently asked questions
What is the best dressing to use for leg ulcers?
Can I undergo laser treatment for my leg ulcer if I have eczema as well?
You can find the answers to these questions and many more in the leg ulcers section of our conditions FAQs page.
If you have any other questions, please do not hesitate to contact us, and a member of our clinic team will be pleased to help.
