Why is Your Leg Ulcer Not Healing? What You Need to Know Now Before It Is Too Late
We get minor injuries like scratches, scrapes, or bug bites that typically heal on their own within a few weeks. However, for some, what begins as a minor wound can evolve into something far more concerning: a leg ulcer that refuses to heal. If you've noticed that a wound on your leg is lingering far longer than expected, it could signal a more significant underlying issue. Understanding why your leg ulcer isn't healing and what steps to take next is crucial in preventing further complications.
What is a Leg Ulcer?
A leg ulcer is an open sore or wound that fails to heal within a standard timeframe, typically around four weeks. These ulcers are often located on the lower extremities, particularly the legs, and can be incredibly painful and debilitating. While anyone can develop a leg ulcer, factors such as age, underlying medical conditions, and lifestyle can increase the risk.
The development of a leg ulcer often begins innocuously, with a minor injury like a scrape or a small wound. Initially, it might seem like any other cut or abrasion, but if it doesn't heal as expected, it can quickly worsen. Over time, the wound can deepen and become more extensive, leading to significant pain, infection, and even more severe complications if left untreated.
What Causes Leg Ulcers?
The key to understanding why your leg ulcer is not healing lies in identifying the underlying cause. Several factors can prevent proper healing, and each needs to be addressed to ensure the ulcer can finally begin to heal.
Peripheral Arterial Disease (PAD)
One of the most common causes of non-healing leg ulcers is Peripheral Arterial Disease (PAD). In PAD, the arteries that supply blood to your limbs become narrowed or blocked, reducing blood flow. Without adequate blood flow, the tissues in your legs cannot receive the oxygen and nutrients they need to heal properly.
If you suspect PAD might be the cause of your non-healing ulcer, it's essential to seek medical evaluation. Tests such as the Ankle Brachial Index (ABI) can help determine if PAD is present and to what extent. The ABI is a simple, non-invasive test that compares your ankle's blood pressure with your arm's blood pressure. A lower ratio suggests reduced blood flow, indicating PAD.
Chronic Venous Insufficiency
Chronic venous insufficiency, another common culprit, occurs when the veins in your legs fail to return blood to your heart adequately. This condition leads to blood pooling in the lower extremities, causing increased pressure in the veins and eventually leading to ulcers. Venous ulcers often occur around the ankles and are characterized by a shallow wound with irregular edges, often accompanied by significant swelling and skin changes like discoloration.
Chronic venous insufficiency can be confirmed through an ultrasound examination, which allows your doctor to visualize the veins and assess the blood flow. Understanding whether your ulcer is due to venous insufficiency is crucial because the treatment strategy will differ from ulcers caused by arterial disease.
Diabetes and Diabetic Neuropathy
For individuals with diabetes, non-healing ulcers are a significant concern. Diabetes can impair wound healing due to high blood sugar levels, which can damage blood vessels and nerves over time. Diabetic neuropathy, a common complication of diabetes, further exacerbates the problem by reducing sensation in the feet and legs. As a result, wounds and ulcers can go unnoticed and untreated for extended periods, leading to severe infections or gangrene.
For patients struggling with diabetic ulcers and skin complications, it's imperative to manage blood sugar levels rigorously and ensure proper foot care. Regular inspections of the feet and prompt treatment of any wounds can prevent minor injuries from developing into more severe ulcers.
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 |
Types of Ulcers
Not all leg ulcers are the same, and understanding the type of ulcer you have can guide the treatment process. The most common types of ulcers include arterial, venous, and diabetic, each with distinct characteristics and treatment protocols.
Arterial Ulcers
Arterial ulcers, typically caused by PAD, are often found on the toes, feet, or areas exposed to pressure, such as the heel. These ulcers tend to be deep, dry, and extremely painful, particularly at night or when the leg is elevated. Due to poor blood circulation, the surrounding skin may appear thin, shiny, and hairless.
The treatment for arterial ulcers focuses on restoring adequate blood flow to the affected area. This might involve lifestyle changes, medications, or surgical procedures to improve circulation. Without addressing the underlying arterial disease, healing is unlikely.
Venous Ulcers
Venous ulcers are usually located in the “gaiter” region of the leg, just above the ankle. They are generally shallow, with irregular edges, significant exudate, or fluid discharge. The skin around a venous ulcer may appear discolored and thickened, and there is often associated swelling.
Compression therapy is the cornerstone of venous ulcer treatment. Compression garments help improve blood flow and reduce swelling by applying pressure to the affected leg. In some cases, treating the underlying venous insufficiency through procedures like vein ablation can prevent recurrence.
Diabetic Ulcers
Diabetic ulcers are often found on the soles of the feet, particularly under calluses, and can be accompanied by other complications like cellulitis or osteomyelitis. These ulcers can vary in appearance but are often characterized by a lack of sensation in the affected area due to neuropathy.
The management of diabetic ulcers requires a multidisciplinary approach. Critical steps include controlling blood glucose levels, protecting the wound from further injury, and addressing any infections. In severe cases, surgical intervention may be necessary to remove infected tissue or improve blood flow.
What Happens if a Non-Healing Ulcer Goes Untreated?
Ignoring a leg ulcer that isn’t healing can have dire consequences. Without proper treatment, ulcers can lead to severe infections, including cellulitis, osteomyelitis (infection of the bone), and, in extreme cases, sepsis—a life-threatening systemic infection. In patients with PAD, untreated ulcers can lead to tissue death, necessitating amputation of the affected limb.
Moreover, the presence of a non-healing ulcer often indicates broader health issues, such as advanced arterial disease or uncontrolled diabetes, which require immediate attention to prevent further complications.
Can a Non-Healing Ulcer Be Treated?
If you have a leg ulcer that isn't healing, seeking professional medical help is crucial. At specialized centers like Center for Vascular Medicine, the focus is on diagnosing and treating the underlying causes of your ulcer to promote healing.
The treatment process typically begins with a thorough medical history and physical examination, followed by diagnostic tests like ultrasound, ABI, or angiography to assess blood flow and identify any blockages or insufficiencies. Based on these findings, your healthcare provider will develop a tailored treatment plan, which may include:
- Medications to improve blood flow, control blood sugar, or treat infections.
- Compression therapy to reduce swelling and improve circulation in venous ulcers.
- Surgical procedures such as angioplasty, stenting, or bypass surgery to restore adequate blood flow in cases of PAD.
Wound care strategies to protect the ulcer, promote healing, and prevent infection.
Throughout the treatment process, close monitoring is essential to ensure the ulcer is healing properly and to adjust the treatment plan as needed.
Can I Prevent Leg Ulcers From Forming?
Preventing leg ulcers requires a proactive approach, particularly if you're at risk due to underlying health conditions such as diabetes, venous insufficiency, or peripheral arterial disease (PAD). Focusing on lifestyle changes, regular monitoring, and appropriate medical care can significantly reduce the likelihood of developing ulcers. Here are some key strategies to help prevent ulcers:
Manage Chronic Conditions
Diabetes: If you have diabetes, controlling your blood sugar levels is crucial. Elevated blood sugar can damage nerves and blood vessels, impairing circulation and wound healing. Regularly check your feet and legs for signs of injury or infection, and consult your healthcare provider if you notice any changes.
Peripheral Arterial Disease (PAD): If you're at risk for PAD, managing cholesterol and blood pressure and engaging in exercise to improve circulation can help. Quitting smoking and eating a heart-healthy diet can also help prevent arterial blockages that lead to ulcers.
Chronic Venous Insufficiency: For those with venous insufficiency, using compression stockings helps improve blood flow and reduce swelling, which can help prevent the formation of venous ulcers.
Maintain Proper Foot and Leg Care
Daily Inspections: Examine your legs and feet daily for cuts, blisters, or signs of infection. If you can’t see the bottoms of your feet, use a mirror or ask for help. Keep your skin moisturized to prevent dryness and cracking, which can lead to ulcers. However, avoid moisturizing between the toes, as this can encourage fungal infections. Wear comfortable, properly fitting shoes and avoid walking barefoot to prevent injuries that can turn into ulcers.
Stay Active
Regular physical activity promotes circulation, which helps prevent the development of ulcers. Exercises such as walking, swimming, or cycling can help improve blood flow in your legs. Consult your healthcare provider before starting an exercise routine if you have an underlying health condition.
Healthy Diet and Weight Management
Maintaining a healthy weight reduces pressure on your legs and improves circulation. A balanced diet of fruits, vegetables, whole grains, lean proteins, and healthy fats can support vascular health and wound healing. Reducing salt intake may also help control swelling in your legs.
Quit Smoking
Smoking negatively affects circulation and can increase the risk of developing ulcers. It damages blood vessels, reducing blood flow and oxygen delivery to tissues, essential for wound healing.
Regular Medical Check-ups
Regularly see a healthcare provider, particularly if you have risk factors for ulcers. Early detection of circulation problems, skin changes, or minor wounds can prevent them from becoming severe ulcers. Depending on your condition, your doctor might recommend specific treatments, such as compression therapy for venous insufficiency or medications to improve blood flow.
Taking these preventive measures can significantly reduce the risk of developing leg ulcers and maintain better overall leg health.
Expert Vascular Care at Center for Vascular Medicine
A non-healing leg ulcer is more than a stubborn wound; it signals something is wrong beneath the surface. Whether it's due to arterial disease, venous insufficiency, or diabetes, the sooner you address the underlying cause, the better your chances of healing the ulcer and preventing severe complications.
If you have a leg ulcer that isn’t healing, seek medical advice immediately. Early intervention can make all the difference, helping you avoid the risks of infection, tissue loss, and, in severe cases, amputation. You can book an appointment with a Center for Vascular Medicine online, call (301) 486-4690, or find a Center for Vascular Medicine location near you.