Why do leg ulcers develop?
These are mainly due to
- Venous insufficiency (that is badly functioning veins)
- Arterial insufficiency (blocked arteries)
- Peripheral neuropathy (impaired sensation, most commonly seen in diabetes)
There are other less common causes but the vast majority of leg ulcers are due to one or a combination of these three problems. The "mixed" ulcers (i.e. due to more than one factor)
are more difficult to cure and are more likely to recur.
If an ulcer is very painful, especially if the pain is worse at night and relieved by hanging the leg down, it is likely there is an underlying arterial problem limiting the flow of blood into the leg. By contrast, legs with chronic venous insufficiency feel more comfortable elevated up on a stool or in bed. Neuropathic ulcers are usually painless.
Treatment of a leg ulcer requires more than dressings, but also correction of the underlying cause.
How Is The Cause Of An Ulcer Established?
Clinical assessment by a vascular surgeon is required to confirm the underlying cause of a leg ulcer. Duplex scanning of the arteries and veins in the affected limb are usually accurate ways of establishing whether there is a disorder of the circulation underlying the ulcer.
Treatment Of Ulcers Due To Artery Blockages
An ulcer that is caused by diseased arteries is usually very painful. Ulcerated legs with poor artery blood flow are referred to as being critically ischaemic (i.e.short of blood)
. Treatment options for this condition are explained in detail in the section of the website devoted to Critical Limb Ischaemia (see Conditions Treated, Prevented and Cured)
Treatment Of Ulcers Due To Problem Veins
Leg ulcers are most commonly due to varieties of varicose veins. In some cases they result from previous deep vein thrombosis. Venous ulcers usually improve rapidly with compression bandaging treatment. This is applied by a specialist nurse and improves the blood flow through the tissues to promote healing of the ulcer. After the ulcer has healed, the compression bandaging is replaced with an elastic compression stocking which is work during the daytime.
Prevention Of Relapse Of Leg Ulceration
Leg ulcers tend to relapse if the underlying cause is not treated. This is why it is important to determine the exact abnormality of the circulation which has led to the ulcer developing in the first place. If the problem is due to a faulty vein, this should be treated. This can usually be done very effectively using one of the modern key-hole vein treatments described in the Treatment, Techniques and Services section of the website. The two main methods are laser therapy and VNUS-Closure. Since these can be performed under local anaesthetic, even very frail patients can be treated to prevent recurrence of the ulcer.
Don't despair. Not all elastic compression stockings are cheap and nasty. The more sophisticated versions provide graduated compression (that is they squeeze more tightly at the ankle than around the calf).
There are numerous varieties, and some are even lined with a fine silver thread which is much less irritant to the skin.
Some patients develop defective deep veins in the leg, for example after a major deep vein thrombosis. This is not easily corrected, either with surgery or with new endovenous treatments. Such patients develop chronic unpleasant symptoms of pain, swelling, skin staining and potential ulceration. In these individuals it is worth investing much time and effort in finding a comfortable elastic compression stocking to relieve symptoms and prevent skin breakdown.