Venous Ulcers

What are venous ulcers?

Ulcers are open skin sores. They can affect any area of the skin. But they most often occur on the legs. Venous ulcers are leg ulcers caused by problems with blood flow (circulation) in your leg veins.

Normally when you get a cut or scrape, your body's healing process starts working to close the wound. In time, the wound heals. But ulcers may not heal without correct treatment.

What causes venous ulcers?

Venous ulcers typically occur because of damage to the valves inside the leg veins. These valves control the blood pressure inside the veins. They allow it to drop when you walk. If the blood pressure inside your leg veins doesn't fall as you're walking, the condition is called sustained venous hypertension. That increase in blood pressure causes ulcers to form on your ankles, where the ulcers most often occur.

Venous ulcers may also be caused by other problems with your leg veins. These include:

• Varicose veins. These are large, bulging leg veins. They occur when valves in the leg veins don’t work well, allowing blood to collect (pool) in the lower leg.

• Chronic venous insufficiency. Like varicose veins, this condition occurs when your leg veins can’t pump blood back up to your heart completely. Blood then pools in your lower legs, making your legs swell. Since the blood can't flow well in your legs, the swelling may be extreme. This extreme swelling can put so much pressure on your skin that venous ulcers form.

Who is at risk for venous ulcers?

People who are older, smoke, have diabetes, or are obese are at increased risk. Having a history of leg injuries, clots (thrombosis), and phlebitis (inflammation of the vein) also increases the risk for venous ulcers.

What are the symptoms of venous ulcers?

Symptoms include pain and the leg feeling heavy, especially when you stand or walk. These symptoms often get worse as the day goes on. Swelling, varicose veins, skin changes, and ulcers develop as more damage occurs to the valves in the legs.

How are venous ulcers diagnosed?

Diagnosis is generally based on a complete health history and physical exam. For your exam, your healthcare provider will look for shallow, painful ulcers over the ankles. The provider will also look for swelling (edema) and skin inflammation (venous stasis dermatitis). If a clear diagnosis can’t be made, additional tests may be done.

How are venous ulcers treated?

Treatment includes:

• Leg elevation. Keeping the leg raised for set amounts of time can help reduce swelling.

• Leg exercises. Ankle flexion exercises and walking can help increase calf muscle strength.

• Compression therapy. This includes compression hosiery or compression bandaging systems and intermittent pneumatic compression machines.

• Skin moisturizers. Use products that don’t contain lanolin, neomycin, or nickel.

For people with venous ulcers, management includes using skin barrier creams and wound dressings. It also includes removing dead tissue to promote healing (wound debridement). Certain medicines used with compression therapy have been shown to speed up the healing of long-term (chronic) venous ulcers. Topical antibiotics, honey, and growth factor medicines are not effective treatments for venous ulcers.

Surgery or a skin graft may be an option for ulcers that are large or don’t respond to standard treatments. Sometimes the affected vein must be found and treated for healing to occur. People who have slow-healing ulcers, recurrent or resistant cellulitis (bacterial infection of the skin), or persistent dermatitis may be referred to a dermatology or wound care specialist.

Can venous ulcers be prevented?

To prevent venous ulcers, you first need to prevent vein problems. You can do this by having healthy habits that help the blood flow in your legs. These lifestyle changes can improve your circulation and reduce the risk for venous ulcers:

• Stop smoking.

• Lose weight if you're overweight or obese.

• Stay at your ideal weight.

• Get plenty of regular exercise.

• Move around often.

• Raise (elevate) your legs for a short time, especially if you've been standing all day.

Wearing compression stockings can also help. They can:

• Prevent blood from pooling in your legs

• Help you prevent severe swelling

• Reduce your risk for venous ulcers

Living with venous ulcers

Venous ulcers need correct care and treatment to prevent infection and to heal. It's important to have any venous ulcers checked right away by your healthcare provider.

Treatment may require focusing on the circulation or vein problems that are causing the ulcers. Or it may mean removing some tissue around the wound. You may be asked to:

• Clean the wound regularly.

• Apply a dressing to the ulcer.

• Don’t use products that cause skin sensitivity.

• Wear compression stockings to prevent blood from pooling in the legs and to speed healing.

• Apply an ointment or another topical medicine as prescribed to prevent or treat an infection.

• Take antibiotic medicines by mouth as prescribed to prevent or treat an infection.

• Have allergy testing done.

Wearing a compression wrap to keep blood flowing back up to your heart can also help ulcers heal more quickly. In some cases, surgery or a skin graft is needed to close up the opening in the skin.

Key points about venous ulcers

• Venous ulcers are open skin sores on the legs. They are caused by problems with blood flow (circulation) in your leg veins.

• People who are older, smoke, have diabetes, or are obese are at increased risk.

• Correct care and treatment are needed to prevent infection and to heal. Have any venous ulcers checked right away by your healthcare provider.

• Symptoms include pain and the leg feeling heavy. These symptoms often get worse as the day goes on. Swelling, varicose veins, skin changes, and ulcers also develop.

• Treatment includes raising your leg, leg exercises, compression therapy, and skin moisturizers. In some cases, surgery or a skin graft may be needed.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.