Why is your leg ulcer not healing? What you need to know now before it is too late.

We all scratch and scrape our legs from time to time, get bug bites, or for one reason or another develop a wound. Typically, these wounds start healing or are fully healed within a few weeks. However, some wounds don’t heal and can go on to develop into an ulcer.

Leg ulcers that aren’t healing can represent an important underlying problem. Getting to the root of the problem is critical in order to get the ulcer to heal.

The picture above is of a patient's left foot showing an ulcer that would not heal properly. After a venous stent, the patient showed significant improvement without recurring ulcers in her foot. Having an ulcer that will not heal can be a warning sign of a major vascular disease. Contact CVM doctor for more information. Ulcer treatment center in Greenbelt, Maryland. 

How will I know if my wound is actually an ulcer?

The first step is to get evaluated by your doctor. They will perform a history and physical to determine what the likely cause of your ulcer is. From there, they can determine if you need further evaluation. They may conduct:

  • Ankle brachial index (ABI): An ABI is a calculation done by measuring the systolic blood pressure reading (top number) in your ankle divided by the systolic blood pressure reading in your arm. This study helps determine if you have peripheral arterial disease (PAD).
    • 1.4 or higher could be due to advanced age or diabetes
    • 1.0 - 1.4 is normal
    • 0.9 - 1.0 is borderline
    • 0.9 or less means you likely have PAD
    • 0.4 - 0.7 moderate PAD
    • Less than 0.4 severe PAD
  • IVUS examination: is an arterial or venous ultrasound is a non-invasive study that uses sound waves to produce images of the blood vessels of the body. The images help determine the size of the vessels, the flow, and more. These studies can help determine if you have arterial or venous insufficiency.
  • An angiogram procedure: is an outpatient procedure performed under light anesthesia to capture an image of the blood vessels. Because arteries are not normally visible by x-ray, a special dye and camera are used to highlight the vessels.

How will I know what type of ulcer I have?

Although there are several types of lower extremity wounds, the most common are arterial and venous ulcers. Venous ulcers are the most common form of lower extremity wound, accounting for 80 – 90% of all leg ulcers.

Other co-morbidities, such as diabetes, may also impact ulcer development and healing potential.

Diabetes interferes with normal wound healing. Diabetic neuropathy may decrease sensation in the feet. Ingrown toenails, cuts, bites, and other wounds may go unnoticed for longer, which may lead to unchecked ulcers. 

The chart below illustrates what type of ulcer you may have and treatment options. 

 

Arterial

Venous

Diabetic

Typical history

Peripheral arterial disease, claudication; rest pain

Venous insufficiency; varicose veins; deep vein thrombosis

Diabetes

Location

Usually over the toes, foot, and ankle; often at pressure points, on the heal, or around the lateral malleolus

“Gaiter” region of the leg – just above the ankle to below the knee; can be on both the lateral and medial aspects of the leg; often above the medial malleolus

Soles of the feet; often under calluses

Wound

Often deep; sloughing; necrotic; yellow, brown, or black in color

Often shallow; large; can be covered with yellow slough or granular tissue

Can be dry or have associated cellulitis, osteomyelitis, or gangrene

Exudate

Typically low/dry

Moderate to heavy

Foul-smelling discharge

Pain

Very painful

Mild, dull, aching pain unless there is also an infection or excessive edema

Pain to touch

Edema

Not commonly

Commonly associated with limb edema

Swelling around the ulcer

Skin changes

Atrophy; gangrene may be present; loss of hair on leg is common; skin around the wound is often thin, dry, and smooth

Shiny skin; venous eczema; lipodermatosclerosis; atrophie blanche; hemosiderosis

Discoloration and warmth; firmness

Treatment

Treat the underlying arterial disease

Compression therapy; treat underlying venous insufficiency with chemical or thermal ablation

Debridement; wound care; maintaining proper blood glucose levels

 

 

 

 

What will happen if I don’t get my PAD treated?

Patients with PAD may have a limited ability to walk, exercise, perform their jobs, or perform their daily activities, impacting their quality of life.

Patients who have PAD are more likely to have blockages in other arteries of the body, especially the arteries of the heart and brain.

PAD symptoms will worsen if left untreated. In the extremities, PAD can lead to limb loss.

What to expect at the Center for Vascular Medicine?

At the Center for Vascular Medicine, our mission is to help patients with their vascular diseases in a cost-effective and compassionate manner. We specialize in the diagnosis and treatment of venous and arterial diseases in the legs, feet, and pelvis. Our world-class providers are the most experienced in the specialty and work with patients to develop a treatment plan that is custom-tailored to their unique situation.

Typically, this process involves an initial consultation and ultrasound scan at one of our accredited facilities. After reviewing the results of your scan and obtaining a thorough medical history, our providers will discuss the results with you and help you decide on the next steps.

Our health care providers use several diagnostic tests to help determine what vascular diseases may be causing your symptoms. Our initial evaluations utilize ultrasound because this non-invasive imaging modality helps us verify our suspicions on whether your symptoms are caused by underlying vascular disease. Contact us if you are suffering from ulcers that will not heal. 

In the video below Dr. Lakhanpal explains leg ulcers of a vascular origin. 

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