Venous Leg Ulcers

What is a venous leg ulcer?

A venous leg ulcer can be defined as an open skin break between the knee and ankle joint that occurs in the presence of venous disease that takes more than two weeks to heal.

What causes venous leg ulcers?

A venous leg ulcer can develop after a minor injury where there is a problem with the flow of blood through the veins of your leg. If this happens, the pressure inside the veins increases and this can gradually damage the tiny blood vessels in your skin and make it fragile. If you then knock or scratch your skin, it can easily break and form an ulcer.  Unless you have treatment to improve the blood flow in the veins in your legs, the ulcer may take a long time to heal.

Who is most at risk?

A number of things can increase your risk of developing a venous leg ulcer, including:

• Being overweight
• Smoking
• If you cannot move around very well
• Sitting for a long period of time
• If you have had a deep vein thrombosis (DVT)
• If you have varicose veins
• If you have previously injured your leg
• Previous surgery to your leg
• A history of self-injecting drugs into the veins of your legs
• Some medical conditions such as diabetes, rheumatoid arthritis and some skin conditions

How do I know if I have a venous leg ulcer?

Venous leg ulcers are open, often painful sores in the skin that have been present for more than two weeks. If you have a venous leg ulcer you may also have:

• Darkening of your skin on the lower leg
• Hardened skin on your leg
• A heavy feeling in your legs
• Aching or swelling in your legs or ankles
• Swollen and enlarged veins on your legs also known as varicose veins

How will I know if I have a venous leg ulcer?

The doctor or nurse will be able to diagnose a venous leg ulcer from your history and examining your affected leg.  Sometimes other simple tests may be required.

What will the doctor or nurse do?

Your doctor or nurse may try to determine the cause of the ulcer by asking about any other health conditions you may have.

They will ask whether you have any additional symptoms, such as swelling in your ankles and discoloured or hardened skin. They will examine both your legs. They will also feel your pulse in your ankles and feet and may listen to them using a hand held machine.

What further tests might I need?

The doctor or nurse will want to rule out other conditions as possible causes of your symptoms. They may carry out a test known as an Ankle Brachial Pressure Index (ABPI) test.

The test involves measuring the blood pressure in the arteries in your ankles and feet then comparing this to the blood pressure in your upper arms. These measurements are taken in a similar way to a usual blood pressure examination, with an inflatable cuff around the arm and then ankle.

The blood pressure in your arteries should be about the same in your arms as in your legs. If the blood pressure in your ankles is lower than that in your arms you may have a condition called, peripheral arterial disease.  Leg ulcers caused by peripheral arterial disease are treated differently from venous leg ulcers.

What treatment will I receive for my venous leg ulcer?

The doctor or nurse will examine your leg ulcer to decide what treatment will be best for you.

• Cleaning and dressing your ulcer. The first step is to ensure the leg and wounds are cleaned. This is usually done by washing your leg in warm tap water. After this, am appropriate dressing will be applied.
• Compression bandages, stockings and garments or wrap garments. One of the main treatments used for venous ulcers is wearing compression therapy to support the veins in your legs.

Compression bandages should always be applied by your nurse. Your doctor or nurse will decide how frequently the bandages need to be changed. 

To be most effective, compression therapy needs to be worn as advised by your doctor or nurse.

Compression wrap garments and stockings are available in a variety of different sizes, colours and styles. Your doctor or nurse can help you find a garment that fits correctly and that you can manage yourself. If your nurse has fitted you with a wrap garment or stockings, you will be shown how to remove and reapply it so you can bathe or shower.

What can I do if I have pain?

When compression therapy is first applied, your venous leg ulcer can become more painful. This can be managed by taking your usual pain killers.  Ask your doctor or nurse if you need any further advice on pain medication.

If you develop severe pain or your toes become blue and swollen, please take off the compression therapy immediately. Keep your leg raised with your heels above your hips in a sitting or lying position and contact your doctor or nurse as soon as possible.

What other symptoms might I have and what can I do to improve them?

People who have venous leg ulcers often have swollen legs, ankles and feet. You can help by keeping your affected leg elevated whenever possible, ideally with your heels above your hips while in a sitting or lying position.

Sleeping in bed at night and not in an armchair is recommended to reduce any swelling in your legs, ankles and feet. Keep as active as possible and continue with your normal activities. Regular exercise, such as a daily walk, will help reduce swelling in your leg.

Regularly exercising your legs by moving your feet up and down and rotating them at the ankles will help improve blood flow. Ask your doctor or nurse to show you the exercises. Be careful not to injure your affected leg.

Some people with venous leg ulcers develop a condition called varicose eczema. This can be treated with a moisturiser and occasionally with a cream or ointment prescribed by your doctor or nurse. If your itching is severe, your doctor or nurse may refer you to a dermatologist (skin specialist) for treatment.

Itchy skin may sometimes be caused by an allergic reaction to the dressings or creams applied.  If this happens, your doctor or nurse may change the dressings or creams. It is important to avoid scratching your legs if they feel itchy, because this could damage your skin and cause more ulcers.

Adopting a healthy life style by stopping smoking, eating a healthy diet, reducing your alcohol intake and not injecting drugs into the veins in your legs can help your ulcer heal faster.

What are the signs that my venous leg ulcer is infected?

Venous leg ulcers can become infected. Your venous leg ulcer may be infected if you experience some or all of the following:

• A high temperature and feel feverish
• Increasing pain to the ulcer or leg
• Unpleasant discharge or smell coming from the ulcer
• Redness and swelling of your skin around the ulcer

If you think your leg ulcer is infected you should contact your doctor or nurse and they will advise you what to do.  They may need to change your treatment plan. If you also feel generally unwell, you should seek urgent medical attention. 

How can I prevent more venous leg ulcers?

People most at risk of developing a venous leg ulcer are those who have previously had a leg ulcer. You can help reduce your risk in several ways by:

•            Wearing the recommended compression therapy
•            Losing weight
•            Stopping smoking/drug misuse
•            Exercising regularly
•            Elevating your legs when resting
•            Sleeping in bed on a night time
•            Taking care of your skin
  

Speak to your doctor or nurse if you need support with any lifestyle changes.

Do I need a further referral for any underlying    problems?

If you have varicose veins and would like to be referred to see if you are suitable for treatment, you can discuss this with your doctor or nurse.

Comments, concerns, compliments or complaints

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