What is a leg ulcer?
A leg ulcer is a chronic sore that can take months to heal. Leg ulcers are usually caused by underlying medical conditions like venous disease, lymphedema, deep vein thrombosis (DVT), peripheral arterial disease, or having had a leg ulcer before. Injury or surgery in the infected leg is another cause of leg ulcers.
Here, we outline how to diagnose the cause of leg ulcers and what your treatment options are.
The photo above is a case of leg ulcers that would not heal. This was an 85-year-old patient with ulcerations of the left ankle, lower extremity edema. The patient was treated with a venogram and venous stenting of the left iliac vein. The after picture shows complete healing of the venous stasis ulcerations.
Step-by-Step Guide to Treating a Leg Ulcer
You should have a doctor or specialist perform an official diagnosis to start an effective treatment plan.
There are a few common symptoms that may lead to a leg ulcer.
- Swollen ankles
- Discolored and darkened skin around the ulcer
- Hardened skin that makes your leg feel hard
- Itchy, flaky skin, also known as varicose eczema
- Open sores to the area that are difficult to heal
- A foul-smelling discharge from the leg ulcer
A doctor will compare your symptoms and your pre-existing conditions to determine possible causes of the ulceration.
Your doctor suggests performing a Doppler study on the arteries or veins in the legs to evaluate for the underlying cause of the ulcers. Your doctor will make this decision based on the appearance of the ulcer, other associated symptoms, and your risk factors for developing either venous and/or arterial disease.
For the doppler study, an ultrasound probe is placed on top of the skin which allows the technologist to visualize blood flow patterns through your arteries or veins. If your doctor suspects arterial disease they may take the blood pressure readings at your ankles and arms and compare them.
Depending on the severity of your pre-existing conditions, your doctor may refer you to a specialist for treatment, including but not limited to wound care management.
There are a few leg ulcer treatment options. Some are non-invasive, while others are more medically involved. Your doctor will choose the best option based on the severity of your condition.
Unlike a regular Ace wrap, a compression bandage is made with a stretchy, elastic fabric that applies pressure to healing areas like legs. Compression bandages work to improve blood flow in the veins, prevent blood clots, and reduce fluid buildup in your leg.
Your doctor or specialist will typically recommend a short compression bandage and stockings for a leg ulcer. These bandages do not increase pressure when you are resting, so some doctors recommend you sleep in them while healing. Although sleeping in compression bandages is not always recommended, so be sure to check with your doctor first.
Your doctor, specialist, or nurse will apply compression bandages to your affected leg. This is a skilled procedure that is best performed by a specialist. It is essential to know that compression bandages are painful when first applied to a leg ulcer, but should dissipate after a week to a week and a half. If it does not, let your doctor know so they can determine if there is a need to cut off your compression bandage. Let your doctor know if you experience any of the following.
- Extreme pain in your ankle
- Extreme pain at the top of your foot
- Discoloration and swelling of your toes
If you cut your compression bandage off yourself, make sure to keep your leg elevated until you can see a doctor again.
You should change the dressing on your ulcer as instructed by your doctor or wound care specialist. You should thoroughly clean it before re-dressing the wound. Frequent cleaning and dressing will prevent infection and allow for your leg ulcer to heal. Be sure to use a non-sticky dressing.
While this process is relatively straightforward, it is best to change your dressing under the supervision of your nurse.
This is a clear, plastic-like dressing that you apply over your sore. You should also wear a stocking with a transparent dressing to keep it in place and improve your leg and foot circulation.
This special bandage has a breathable outer layer to prevent infection and an inner layer that absorbs drainage from your leg ulcer to promote healing. Hydrocolloid dressings also remove dead skin and tissue.
If your leg ulcer is not healing through compression and dressing, you may need surgery to correct and improve blood flow in your leg.
Shave therapy involves removing dead or non-healing tissue and then skin grafting. A surgeon will shave down 0.3 to 0.4 mm of non-healing skin and tissue and then use a skin grafting machine to graft skin of the same thickness (usually from the affected leg) to the area they are working on.
Your doctor or specialist will review your ulcer and history to determine if shave therapy is right for you.
This type of surgery removes dead, damaged, or infected tissue from your leg ulcer to help the remaining tissue heal. A surgeon will use a scalpel not only to remove tissue but also to determine the depth of the sore and remove any foreign objects that may be lodged in your leg.
Less invasive debridement involves applying gel or hydrocolloid dressings to your sore to remove damaged tissue by the medication.
There are benefits to having surgery done as part of your leg ulcer treatment. Surgery can stimulate the edge of the wound to begin healing and reduce inflammation. It also removes dead skin and tissue, preventing infections that could eventually lead to amputation.
Treating an Infected Ulcer
If your ulcer becomes infected, you may have to treat it with antibiotics and topical creams. If the infection becomes more chronic or severe, you may need surgery. Properly cleaning and dressing your ulcer may prevent it from becoming infected.
Your prognosis depends on the severity of the ulcer and your pre-existing conditions. Treatment for chronic wounds in the legs and feet are traditionally challenging.
For venous ulcers, compression therapy works well. However, you may also require surgery, including shave therapy and plastic surgery, to see more long-term results. Shave therapy has shown positive, long-term results in leg ulcer patients.
It is important to closely monitor and manage diabetes if you have any active ulcers. Elevated/uncontrolled glucose levels can increase risk of infection and slow the healing process.
What to expect after treatment with CVM?
At CVM, we're ready to help diagnose and treat your leg ulcers at our select wound care locations:
Our expert team will carefully consider all potential chronic pelvic pain causes, with a special emphasis of diagnosing any potential vascular disorders.
We provide complete chronic pelvic treatment for pain. Aside from implementing innovative techniques to treat your pain, including treatments for vascular issues, we're committed to listening to your concerns and treating your pain seriously. Many of our patients go on to have significant improvement or resolution of their symptoms.
What Are Some Home Remedies?
You should always see a doctor about a severe medical condition. However, there are some things that you can do at home to prevent/treat a leg ulcer.
Use of Compression Stockings
Use of compression stockings/socks helps to reduce edema and strain on the skin from the increased pressure with swelling
Elevating your legs helps blood circulate back to your heart. When you are sleeping, prop your feet up 6 inches with a pillow. When you are awake, elevate your legs above your heart for 30 minutes and three to four times per day.
Maintain Healthy Skin
Keep the skin of your lower legs clean and well moisturized. Choose a cream/lotion that does not contain alcohol which may cause further drying and cracking of the skin. Do not apply lotions/creams to any areas of active ulcers unless prescribed. Avoid any injury to the skin tissues. Notify your physician if any open sores appear on the skin.
Exercise is also a great way to increase circulation. Try foot and ankle exercises to improve blood flow. Flex your ankles by pointing your toes up and then away from you. You can do this sitting or standing.
Flex up to 10 times and repeat throughout the day.
If you are able, walking is also an effective way to increase circulation in your legs and feet.
In the video below Dr. Lakhanpal briefly explains leg ulcers including venous leg ulcers.
In the video below Dr. Pappas briefly explains common leg ulcers and what vascular conditions cause leg ulcers.