Leg ulcers – guide for patients and carers

This easy to follow guide for patients and carers explains what a leg ulcer is and gives an overview of the symptoms, causes and treatment.

What is a leg ulcer?

A leg ulcer is a break to the skin below the knee which has not healed within two weeks. Venous leg ulcers are the most common type of ulcer accounting for around 60 to 80 per cent of cases.

Venous leg ulcers develop as a shallow sore below the knee, typically near and above the ankle due to poor vein function. These are often painful, long lasting and have a substantial impact on wellbeing, especially if they reoccur.

Who is at risk of developing a venous leg ulcer?

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

obesity or being overweight – increases the pressure in the leg veins
if you have difficulty walking – this can weaken the calf muscles, which can affect circulation in the leg veins
previous deep vein thrombosis (DVT) – blood clots that develop in the leg can damage valves in the veins
varicose veins – swollen and enlarged veins caused by malfunctioning valves
previous injury to the leg, such as a broken or fractured bone, which may cause DVT or affect your walking
previous surgery to the leg, such as a hip replacement or knee replacement, which can prevent you moving about
increasing age – people find it harder to move around as they get older, particularly if they suffer from arthritis.

What causes a venous leg ulcer?

A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. This happens when the pressure inside the veins increases.

This constant high pressure can gradually damage the tiny blood vessels in your skin and make it fragile. As a result, your skin can easily break and form an ulcer after a knock or scratch.

Unless you have treatment to improve the circulation in your legs, the ulcer may not heal.

Symptoms of a venous leg ulcer

If you have a venous leg ulcer, you may also have:

swollen ankles (oedema)
discolouration or darkening of the skin around the ulcer
hardened skin around the ulcer, which may make your leg feel hard
a heavy feeling in your legs
aching or swelling in your legs
flaky, scaly and itchy skin on your legs (varicose eczema)
swollen and enlarged veins on your legs (varicose veins)

Signs of an infection

A venous leg ulcer can be susceptible to bacterial infection causing:

worsening pain
a green or unpleasant discharge coming from the ulcer – redness may be harder to see on black or brown skin
redness and swelling of the skin around the ulcer
a high temperature (fever)
an unpleasant smell coming from the ulcer

What to do if you think you have a venous leg ulcer

See your GP if you think you have a venous leg ulcer. The ulcer is unlikely to heal without specialist treatment and you may be referred to our District Nursing or Tissue Viability service for this.

Treatment for venous leg ulcers

With appropriate treatment, venous leg ulcers often heal within six months. Treatment should always be carried out by a healthcare professional trained in compression therapy for leg ulcers.

The leg ulcer will firstly be cleaned before the application of an appropriate dressing to provide the best conditions for the ulcer to heal. Dressings usually need to be changed one to three times a week.

Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.

Compression therapy

If there are problems with healing this is usually because there are problems with the blood return
from the leg to the heart. If there is a good blood supply to the legs, then your health care
professional may offer compression therapy to improve circulation in your legs and treat swelling.

Compression therapy involves applying firm compression over the affected leg to squeeze your legs and encourage blood to flow upwards towards your heart. It is very effective at helping leg wounds heal faster, reducing swelling and preventing ulcers coming back.

This can be done by bandaging, compression hosiery (socks, stockings or tights) or by wrap
systems. There are lots of different types of compression therapy so there will be something that
suits you.

Compression can be a little uncomfortable when you first start treatment but should not cause you
any pain. Any discomfort should reduce as the swelling goes down. If you do experience discomfort,
talk to your health care professional and they will suggest ways to reduce the discomfort.

How to apply compression hosiery

Tips for looking after yourself during treatment

To help your ulcer heal more quickly:

Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse.
Keep your affected leg elevated whenever you’re sitting or lying down.
Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation.
Try to reduce your weight if you’re overweight with a healthy diet and regular exercise.
Stop smoking and moderate your alcohol consumption. This can help the ulcer heal faster.
Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear.