Venous Leg Ulcer

Overview

A venous leg ulcer is an open sore that develops on the lower leg, usually between the knee and the ankle, when blood flow in the leg veins is not working properly. Veins normally carry blood back to the heart. When the valves inside the veins become weak or damaged, blood can pool in the lower legs, increasing pressure in the veins. Over time, this pressure can affect the skin and underlying tissues, making them fragile and slow to heal.

Venous leg ulcers are a common reason for referral to vascular surgery and wound care specialists. They can be long-lasting and may come back if the underlying vein problem is not managed. With appropriate assessment, wound care, compression therapy and treatment of venous disease when suitable, many people can achieve better healing and reduce the risk of recurrence.

Symptoms

A venous leg ulcer typically appears as a shallow open wound on the lower leg, often around the inner ankle. The skin around the ulcer may look red, brown, purple or hardened. The wound may produce fluid, and the surrounding skin can feel itchy, dry or irritated.

Common symptoms and signs may include:

• An open sore on the lower leg that is slow to heal
• Swelling in the ankle or lower leg, often worse later in the day
• Aching, heaviness or tightness in the leg
• Skin discoloration, especially brown staining around the ankle
• Thickened, dry, flaky or itchy skin
• Fluid leakage from the wound or surrounding skin
• Unpleasant odor or increasing pain if infection develops

Symptoms can vary from person to person. Some ulcers cause significant discomfort, while others may be less painful. Any non-healing wound on the leg should be assessed by a healthcare professional.

Causes and Risk Factors

The main cause of a venous leg ulcer is chronic venous insufficiency. This means the veins in the legs have difficulty moving blood back toward the heart. When blood pools in the lower legs, pressure inside the veins rises and can damage the skin over time.

Factors that may increase the risk of venous leg ulcers include:

• Varicose veins or a history of vein valve problems
• Previous deep vein thrombosis or blood clots in the leg
• Long-term leg swelling
• Previous leg injury or surgery
• Reduced mobility or spending long periods sitting or standing
• Older age
• Excess body weight
• Smoking, which can affect blood vessel health and healing
• Other conditions that affect circulation or wound healing

Not all leg ulcers are venous. Some are related to artery disease, diabetes-related nerve or circulation problems, pressure injury, inflammation or other medical conditions. Correct diagnosis is important because treatment depends on the cause.

Diagnosis

Diagnosis begins with a medical history and physical examination. The healthcare team will look at the wound, the surrounding skin, leg swelling and any signs of infection or circulation problems. They may ask about previous vein problems, blood clots, injuries, surgery, mobility, pain and how long the ulcer has been present.

Tests may be used to check blood flow and identify the underlying cause. A common test is an ultrasound examination of the leg veins, which can show whether blood is flowing normally or refluxing backward through weakened valves. Assessment of the arteries in the legs may also be needed, especially before compression treatment is started, because compression may not be suitable for some people with significant artery disease.

In some cases, additional tests may be recommended if the ulcer has an unusual appearance, does not improve as expected, or if another condition is suspected. A specialist assessment helps create a treatment plan that is safe and appropriate for the individual patient.

Treatment Options

Treatment for a venous leg ulcer usually has two main goals: helping the wound heal and addressing the underlying venous circulation problem to reduce the chance of recurrence. Care is often provided by a team that may include vascular surgeons, wound care nurses and other specialists.

Compression therapy is a central part of treatment for many venous leg ulcers. It helps reduce swelling and improves blood return from the leg. Compression may involve special bandages or medical compression stockings, selected and applied by trained healthcare professionals after circulation has been assessed.

Wound care is also important. This may include cleaning the wound, choosing appropriate dressings, protecting the surrounding skin and monitoring for infection. The type of dressing depends on the wound’s size, depth, fluid level and skin condition. Patients are advised not to apply home remedies or unapproved products to an ulcer without medical guidance.

If there is significant venous reflux or varicose vein disease, procedures to treat the affected veins may be considered. These may include minimally invasive techniques or surgery, depending on the patient’s anatomy, general health and test results. The aim is to improve venous circulation and support long-term ulcer management.

Lifestyle and supportive measures may also be discussed, such as leg elevation when appropriate, regular safe movement, skin care, weight management and smoking cessation support. These measures are part of overall care but should be tailored to the individual’s medical condition.

When to See a Doctor

Medical advice should be sought for any wound on the lower leg that does not heal, especially if it lasts more than a short time, is getting larger, or is associated with swelling or skin discoloration. Early assessment can help identify the cause and prevent complications.

Urgent medical attention is needed if there are signs of infection or worsening circulation, such as increasing redness, warmth, swelling, pain, pus, fever, a bad odor from the wound, sudden color change in the foot, numbness, or severe pain. People with diabetes, known circulation problems, immune system conditions or a history of blood clots should seek prompt care for any leg wound.

A venous leg ulcer can be challenging, but specialist evaluation and a structured care plan can help manage the wound, improve comfort and address the underlying vein disease where possible.