Leg ulcers or chronic venous leg ulceration are most often found on the lower leg and ankle. The most common cause is poor circulation. Age, varicose veins, smoking and arterial disease increase the risk of leg ulcers. Treatment options include compression bandages, dressings and surgery. Keeping the affected leg elevated above the level of the heart can help.
Around one per cent of the Australian population suffers from leg ulcers (chronic venous leg ulceration). The most common cause is poor blood circulation, particularly the inability of the veins to return deoxygenated blood from the legs back to the heart.
Other causes or risk factors include prolonged pressure on an area (such as long-term lying in bed in one position, which may cause bed sores), badly managed diabetes, high cholesterol, smoking, dietary problems and poor arterial circulation.
Older people are at greater risk, and the number of women with leg ulcers is slightly higher than men because women have a longer lifespan. Treatment options include compression bandages, medication, surgery and (more recently) hyperbaric oxygen therapy.
Symptoms of leg ulcers
Symptoms of a leg ulcer include:
- They are commonly found on the lower leg and ankle
- A sunken, asymmetrically shaped wound
- The edges of the ulcer are clearly defined from the surrounding skin
- The surrounding skin is intact, but inflamed
- The surrounding skin may be pigmented, hardened or calloused
- Yellowish-white exudate (pus)
- Pain, particularly while standing
- Varicose veins in the leg.
Leg ulcers, the calf muscle and poor circulation
Generally, veins carry deoxygenated blood from the body to the heart, then on to the lungs. Veins have one-way valves to prevent blood from running backwards. The contraction of muscles helps to massage blood along the veins.
The calf acts as a pump, using muscular contraction in combination with deep veins and chambers to help push the blood back up through the veins. This pumping action can be affected by a variety of problems, including blockages in the deep veins, venous insufficiency or venous disease.
It is not known how poor vein circulation triggers a leg ulcer. One theory proposes that white blood cells from the immune system are trapped inside the tiny capillaries, where they then attack and destroy the nearby skin tissue. High numbers of white blood cells and their by-products have been found in the pus of leg ulcers.
Risk factors for leg ulcers
A number of different factors can increase a person’s risk of chronic venous leg ulceration, including:
- Age – peripheral circulation becomes less efficient with old age.
- Varicose veins – the one-way valves that stop blood from travelling backwards in the vein stop working. The pooling of blood stretches and distorts the vein.
- Cigarette smoking – tobacco is known to constrict the vessels of the circulatory system.
- Arterial disease – vein problems are more likely if the person already has other diseases of the arteries.
- Certain disorders – these include diabetes and arthritis.
- 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.
- Medication – some cardiovascular medications can contribute to leg oedema (swelling due to a build-up of fluid) and altered circulation.
Treatment for leg ulcers
Treatment for chronic venous leg ulceration includes:
- Cleaning the wound – using wet and dry dressings and ointments, or surgery to remove the dead tissue
- Specialised dressings – a whole range of products are available to help the various stages of wound healing. Dressings are changed less often these days, because frequent dressing changes remove healthy cells as well.
- Occlusive (air- and water-tight) dressings – ulcers heal better when they are covered. These dressings should be changed weekly.
- Compression treatment – boosts internal pressure, using either elasticised bandages or stockings. This is particularly effective if multiple layers are used.
- Medication – includes painkillers, and oral antibiotics if infection is present.
- Supplements – there is evidence that leg ulcers may heal faster with mineral and vitamin supplements, but only if the person suffers from a deficiency. Zinc, iron and vitamin C may be used.
- Skin graft – is a surgical procedure, where healthy skin is grafted onto the prepared wound site.
- Skin cancer and infection –if ulcers fail to heal or if they increase in size, both these conditions will need to be ruled out.
- Hyperbaric oxygen – this is now an accepted treatment for ulcers that resist other methods of healing, such as diabetic ulcers.
Long-term outlook after a leg ulcer
Unless the underlying conditions that contributed to your leg ulcer are addressed and treated, you are at risk of developing other ulcers. Options can include treatment for varicose veins, quitting cigarettes, improving your diet and taking regular exercise (such as 30 minutes of walking every day). You should avoid hot baths and sitting still for too long. It can help to keep the affected leg elevated above the level of your heart whenever practical.
Where to get help
- Your doctor
Things to remember
- Leg ulcers affect around one per cent of the Australian population.
- The most common cause is poor circulation.
- Treatment options include compression bandages, dressings and surgery.
You might also be interested in:
- Bairnsdale ulcer.
- Circulatory system.
- Pressure sores.
- Wounds - how to care for them.
- Wounds - lower leg ulcers.
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This page has been produced in consultation with and approved by:
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North East Valley Division of General Practice
Fact sheet currently being reviewed.
Last reviewed: September 2011
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