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Leg Ulcers

The below content has been medically reviewed and approved by Consultant Vascular Surgeon Mr. Wissam Al-Jundi (MBBS, FRCS), Deputy Medical Director and member of the Medical Advisory Committee at Veincentre.

Last reviewed 17th October 2021.

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Overview of Leg Ulcers

Here at Veincentre, we have almost 20 years’ experience in treating venous leg ulcers via EVLA and foam sclerotherapy. We find that these methods lead to quicker healing and longer-lasting results (they tend to remain healed) in comparison to traditional methods like only applying compression bandaging.

A leg ulcer is any break in the skin, usually found on the lower part of the leg or the feet. They are typically diagnosed on their appearance, which in itself can be confusing as they can have so many different appearances. Leg ulcers develop when an area of skin breaks down to reveal the underlying flesh. Venous ulcers are the most common type of leg ulcer, accounting for around 80% of leg ulcers according to NHS statistics. It is estimated that the condition affects as many as 1 in 50 older age adults. They mainly occur just above the ankle and are often very painful.

The NHS treatment for venous ulcers remains a cleaning and dressing procedure, complete with compression, performed in the community, over a long period of time. There is inconsistency in referring patients with leg ulcers for assessment of their veins and the referral pathways in the NHS take a considerable time before patients arrive at the doorstep of a vascular specialist. Without addressing the underlying cause of the condition timely, healing can be delayed, and recurrence rate is high.

Venous leg ulcer before treatmentVenous leg ulcer after treatment

Leg Ulcers Symptoms

Venous leg ulcers are open sores, usually found on the lower leg, that can be painful and slow to heal.

Typical symptoms which may manifest themselves include varicose veins, varicose eczema, swollen ankles, a feeling of heaviness in the legs, discolouration or hardening of the skin and achy legs. Some leg ulcers may also have a foul-smelling discharge from the ulcer.

Some of those symptoms are worsened when the patient is sitting or standing, as the leg is below the heart, amplifying the effect of the venous insufficiency. In contrast, those patients who are able to rest either lying down or with their leg elevated show signs of those symptoms easing as gravity works with the body to move blood back to the heart.

Leg Ulcers Causes

Fundamentally, leg ulcers are caused by increased blood pressure caused by problems with the circulation of blood in the leg veins. The skin of the leg can gradually get damaged and can be made fragile by the constant high pressure (venous hypertension).

Venous hypertension is usually due to valve failure, i.e. venous incompetence, which is the normal cause of varicose veins. In our experience most patients with leg ulcers will also have varicose veins (or have a history of them). Venous hypertension can lead to complications such as eczema, skin discolouration and eventually ulceration.

Venous ulcers account for more than 3/4 of all leg ulcers, while arterial leg ulcers that are developed from similar problems in arteries rather than veins, account for around 15% of all cases. Fortunately, venous ulcers also represent the simplest to treat and cure. An ultrasound scan will help us to determine the underlying cause and it could even be found that there is a mixture of venous and arterial insufficiency.

Leg Ulcers Diagnosis

By their very nature, leg ulcers are easy to identify from the fact that they are obvious sores on the skin of the lower leg. Traditional diagnosis has mainly been based on the symptoms and superficial examination of the affected area. This may well be done both while standing and lying down. Any visible varicose veins would be easier to identify whilst standing and it would be easier to identify and take a pulse in the ankles whilst lying down.

At Veincentre, we look to detect any underlying problem that is presenting the leg ulcers, and we can only say that an ulcer is venous by undertaking a colour duplex ultrasound scan and demonstrating reflux.

Leg Ulcers Prevention

Leg ulcers do present early signs that may not be recognised by many. The skin of the lower leg can become discoloured and turn into a brown patch, usually on the inside of the area. If left untreated this can turn to a dark brown patch and eventually become ulcerated.

Traditionally, GPs have suggested that compression bandaging or compression stockings to help to improve circulation within the affected area, encouraging blood flow from the feet to the heart. Whilst compression therapy is vital part of managing venous ulcers, this should be augmented with ablation of any underlying superficial venous reflux. Indeed, the best way to prevent the development and recurrence of venous leg ulcers is to treat the underlying cause with EVLA.

In most cases, after the ulcer has healed post-EVLA, it will not be necessary to wear compression stockings, which means that you can get on with normal life.

Treatment

At Veincentre, our treatment pathway for leg ulcers is similar to that for varicose veins. Leg ulcer treatment would start with a 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.

We suggest that treating the underlying cause of venous insufficiency with EVLA will produce the best long term results. To find out about our treatments in more detail, please read here.

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