What is a venous leg ulcer?

A venous leg ulcer is an open, often painful, sore in the skin on the leg below the knee. The ulcers usually develop on the inside of the leg and take more than 2 weeks to heal.

Venous leg ulcers are caused by disease or disrupted vein function, also known as chronic venous insufficiency (CVI) and ambulatory venous hypertension.

Chronic venous insufficiency usually results from damage to the valves in the leg veins (for example, varicose veins) or as a result of venous thrombosis.1 

Ambulatory venous hypertension occurs in patients with varicose veins, when there is an inadequate decrease in venous pressure while walking and exercising.

Indicators of Venous & Arterial disease

Indicators of underlying Venous disease

Significant past medical history of:

  • Deep Vein Thrombosis (DVT)
  • Pulmonary Embolism (PE)
  • Lower limb fracture
  • Family history of venous disease
  • Varicose veins

  Indicators of venous disease:  

  • Ankle flare
  • Varicose veins
  • Pigmentation and staining
  • Lipodermatosclerosis
  • Oedema
  • Eczema/dry skin
  • Atrophie blanche
  • Pain and heavy feeling in legs

Risk factors:

Medical conditions

  • Hypertension
  • Chronic oedema
  • Hormonal
  • Arteriovenous fistula

Lifestyle

  • Obesity
  • Physical Inactivity
  • Stress
  • History of intravenous drug use
  • Occupation/hobbies
  • Multiple pregnancies
Indicators of underlying Arterial disease

Significant past medical history of:

  • Cardiovascular problems
  • Stroke
  • Myocardial Infarction
  • Angina

  Indicators of arterial disease:  

  • Intermittent claudication
  • Pain on leg elevation
  • Cold extremities
  • Discoloured toes
  • Thick and slow growing toenails
  • Dependent rubor
  • Absent foot pulses
  • Pale shiny hairless skin
  • Deep and punched out ulcers
  • Ulcers more common on the lateral malleolus and dorsum of the foot

Risk factors:

Medical conditions

  • Hypertension
  • Diabetes
  • Rheumatoid Arthritis
  • Hormonal

Lifestyle

  • Smoking
  • High cholesterol
  • Obesity
  • Physical Inactivity
  • Stress

Definition of a leg ulcer

Wound to the lower leg that remains unhealed after 4-6 weeks (1,2) as a result of underlying aetiology.

A leg ulcer is not a disease, but a symptom of a disorder.3

Sound knowledge of the skin, lymphatics and vascular systems is essential to understand the aetiologies, prevalence and management of leg ulceration.4

“An open lesion between the knee and the ankle joint that occurs in the presence of venous disease and takes more than two weeks to heal” 

If present for 2 weeks, assess for suitability for compression.

Immediate treatment with compression if indicated.