Venous leg ulcers

A venous leg ulcer is a wound on your leg that takes a long time to heal due to poor blood circulation. It usually develops on the inside of your lower leg, above your ankle.

Key points

  1. Often an ulcer will develop after a minor injury to your leg, and because of blood circulation problems, the wound fails to heal.
  2. Venous leg ulcers can be painful and itchy and cause swelling on your affected leg.
  3. A venous leg ulcer usually won’t get better without treatment, which commonly involves specialist wound care and compression therapy.
  4. You’re more at risk of developing a venous leg ulcer if you are overweight, have a history of varicose veins or deep vein thrombosis (DVT), have limited mobility, have had a previous venous leg ulcer or are aged over 60.
  5. Lifestyle changes, such as healthy eating, regular exercise and maintaining a healthy weight can reduce your chances of developing a venous leg ulcer.

What are the symptoms of a venous leg ulcer?

The most common symptom of a venous leg ulcer is a wound that doesn’t heal and is irregularly shaped with dry, hard skin around the outside. Other symptoms include:

  • swelling, especially around the ankle of your affected leg
  • aching legs
  • pain
  • clear discharge.

Venous leg ulcers are at risk of becoming infected because they’re slow to heal. Signs of an infected leg ulcer include:

  • increased pain
  • green, smelly discharge
  • developing a temperature
  • an increase in swelling and redness around the wound.

What are the causes of a venous leg ulcer?

Venous leg ulcers develop because of problems with the blood circulation in your leg veins. Valves in your legs help to push blood from your legs and feet back up towards your heart. If these valves become damaged, the blood pools in the leg veins, causing pressure symptoms and skin changes.

Often an ulcer will develop after a minor injury to your leg, and because of blood circulation problems, the wound fails to heal.

You’re more at risk of developing a venous leg ulcer if you:

How is a venous leg ulcer diagnosed?

A venous leg ulcer is usually diagnosed based on what it looks like, how long it has been there, your history and other risk factors. Your GP may organise other tests to see if you also have peripheral vascular disease or check your circulation before starting treatment.

What is the treatment for a venous leg ulcer?

A venous leg ulcer usually won’t get better without treatment from a healthcare professional. The aim of treatment is to make sure the wound heals while providing relief from symptoms such as pain in and swelling of your affected leg.

Your GP may recommend specialist wound care and compression therapy to help with healing. Treatment will usually be done by a district nurse who is specifically trained to manage leg ulcers.

Compression therapy applies pressure to your affected leg, which reduces the amount of blood pooling in the veins and helps to redirect the blood flow to your heart. It can help to reduce swelling and encourages delivery of oxygen and nutrients, critical for healing, to the wound. 

Your GP may consider referral to a vascular surgeon to discuss a minimally invasive procedure for varicose veins. This will reduce the risk of recurrent ulcers.

What self-care can I do with a venous leg ulcer?

Once treatment has started, venous leg ulcers can still take a few months to heal. You’re more at risk of developing another one if you don’t treat the underlying cause of the ulcer. Although some venous ulcers are unavoidable, there are a few things you can do to minimise your chance of developing one:

  • maintain a healthy weight
  • exercise regularly
  • eat a healthy diet
  • avoid sitting or standing for long periods
  • raise your feet as close to hip height as you can during the day to help with the return of blood flow to your heart.

Sometimes having varicose veins surgically treated can also help.

Learn more

Venous ulcer DermNet New Zealand, 2016
Chronic venous insufficiency and leg ulcers Australian and New Zealand Society for Vascular Surgery, 2018

References

  1. Australia and New Zealand Clinical Practice Guideline for Prevention and Management of Venous Leg Ulcers New Zealand Wound Care Society, 2011
  2. Treating venous leg ulcers New Zealand Wound Care Society, 2013

Reviewed by

Dr Lupe Taumoepeau is a vascular and transplant surgeon at Wellington Hospital. While she is involved in all forms of open and endovascular surgery, her interests include management of diabetic foot disease, complex endovascular aortic surgery and renal transplant. She is also actively involved in prevocational medical education and mentoring of women wanting to pursue a career in surgery.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Lupe Taumoepeau, vascular surgeon, Wellington Last reviewed: 27 Jun 2019