Vein Conditions
Venous Ulcers
Causes & Treatments
A venous ulcer is a full-thickness skin wound on the leg or foot that can result from various underlying conditions, most commonly linked to arterial, vascular, or neuropathic diseases. Leg ulcers can be classified as either acute or chronic.
What Causes Venous Ulcers
Healthy leg veins contain valves that ensure blood flows towards the heart. Venous reflux occurs when these valves malfunction, causing blood to flow backwards and accumulate in the veins of the lower legs.
A venous ulcer can develop due to injury or prolonged pressure, such as from a plaster cast or an ill-fitting ski boot. Bacterial infections, including impetigo, ecthyma, and cellulitis, are also common causes. In rare cases, conditions like tropical ulcers, tuberculosis, or leprosy may lead to ulcer formation.
Venous Ulcers
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What are the Symptoms of Venous Ulcers?
A venous leg ulcer often manifests as a non-healing wound with an irregular shape, encircled by dry, hardened skin. These ulcers typically appear below the knee, most commonly on the inner part of the lower leg just above the ankle.
Additional symptoms may include:
– Swelling, particularly around the ankle of the affected leg
– Aching sensations in the legs
– Pain
– A clear fluid discharge
– Red-brown discolouration on the impacted skin
Due to their slow healing nature, venous leg ulcers are prone to infections.
Indicators of an infected ulcer may involve:
– Heightened pain
– Green, foul-smelling discharge (pus)
– Fever (elevated body temperature)
– Increased swelling and redness surrounding the wound
Who is at Risk of Developing Leg Ulcers?
Several factors have been associated with the development of venous and arterial leg ulcers, including:
- Stasis ulcers
- Varicose veins
- A history of leg swelling
- Previous deep vein thrombosis (DVT), which can lead to post-thrombotic syndrome (occurring in around 5% of cases)
- Prolonged sitting or standing
- High blood pressure
- Multiple pregnancies
- Past surgeries
- Fractures or injuries
- Obesity
- Advancing age and reduced mobility
Venous Ulcers Treatment
Treatment for venous ulcers focuses on addressing the underlying causes. Since ulcers often stem from both arterial and venous conditions, an accurate initial assessment is crucial.
For venous leg ulcers without arterial involvement, treatment typically includes exercise, resting with leg elevation, and the application of compression therapy. However, compression should be avoided in cases of significant arterial disease, as it can worsen inadequate blood flow. Surgical options, ultrasound-guided sclerotherapy, or endovascular laser treatment of the superficial and perforator veins might be beneficial, especially if the deep venous system remains unaffected. Venous-return assisted calf compression devices can also provide additional benefits.
A vascular surgeon will assess patients with arterial leg ulcers to determine the appropriate treatment, which may involve surgery to address arterial narrowing.
Managing underlying conditions such as diabetes and encouraging smoking cessation are also essential components of the treatment plan.
