A venous leg ulcer is an open spot or sore on the lower leg. The normal skin has disappeared at that location, so that an erratic bordered open spot emerges, which is often covered with a yellow-brown layer or crust. The bottom may initially be black with dead skin. The cause is usually a long-lasting disorder in the blood vessels.
Venous leg ulcer can be caused by a disorder in the supplying arterial system or a defect in the draining veinous system. In the first case, there is narrowing of the arteries, causing too little oxygen and nutrients get into the tissues, making them die. This leads to very painful open spots, which are generally difficult to heal. These open spots are usually located on the toes and feet and/or at the outside of the leg.
The most common cause of a venous leg ulcer is, however, a defect in the veinous system. Here, the blood is drained insufficiently, which leads to an accumulation of blood (congestion).
In the veins are valves that prevent the backflow of blood to the feet in vertical position. If these valves no longer close properly, blood flows back easily, so that the pressure in the veins and capillaries increases. Due to the stagnation in the bloodstream, the nutrition of the tissues is in danger. The skin becomes more vulnerable and a venous leg ulcer easily develops. A previously experienced blockage of the veins (thrombosis) is the major cause of valves that no longer close properly.
A tired, heavy feeling in the legs is often the first symptom of a discharge disorder of the blood vessels. During the day, the ankles thicken due to fluid retention (edema). After some time, expanded veins and varicose veins are visible. There may be brown discoloration and eczema spots. Subcutaneous hardenings can also occur. Ultimately, there is an ulcer. The ulcer is usually not painful, but can stink and produce a lot of moisture, so the patient cannot go anywhere and whenever he or she wants. The open spots are usually found around or just above the inside of the ankle and can grow into a large wound.
The doctor examines which vascular defect underlies the venous leg ulcer. Feeling the leg arteries beating or measuring blood pressure there is sufficient to exclude a supply disorder in the arterial system.
A venous leg ulcer on the basis of a drainage failure in the venous system is usually easily to recognize as such. Additional examination is sometimes needed. Usually, a doppler or duplex device is used. This way, the blood flow is made audible, it is possible to determine the direction of the blood flow in the veins and the doctor can examine how severely the veins are damaged.
To determine the effect of damage to the valve on the pressure in the veins - and the associated amount of moisture in the leg - plethysmographic examination may be carried out. This determines how much blood is pumped up by the calf muscles and how quickly the leg fills itself again. In the event of not properly closing valves, the blood falls as it were straight down and fills the leg rapidly again.
Additionally, X-ray examination is sometimes required. Here, a contrast agent is injected into the veins, making them visible.
The main purpose of treating a venous leg ulcer is to improve the drainage of blood from the leg to the heart. The supply of nutrition in the lower leg improves and the open spot will close. This can be achieved by the application of special pressure bandages. The final piece of treatment of a venous leg ulcer, caused by a drainage disorder, is wearing an elastic stocking. This is to prevent new open spots. The stockings must be worn permanently. Sometimes, the drainage of blood can be fully restored by surgery to the varicose veins.
If a supply disorder, due to a narrowing in one or more arteries, is the cause of a non-healing venous leg ulcer, the doctor can attempt to eliminate this narrowing in the artery with a catheter (angioplasty) or to create a bypass.
A venous leg ulcer, caused by a drainage disorder, is generally no threatening disease. But the patient is handicapped by it. In most cases, wearing elastic stockings can prevent much misery. A healed venous leg ulcer will, however, easily get broken again if there is moisture in the leg.
In case of a supply disorder, the prospects are much less favorable. The cure is difficult. If the blood vessel gets even further clogged, an amputation of the foot or the lower leg is sometimes necessary.
- Move plenty (walking, cycling, swimming) and thereby wear elastic stockings (also in hot weather). This is the main regimen. Just on hot days, the stockings are often most needed.
- Don’t stand still for too long, but sit down and put the leg high. Only when the moisture from the lower leg is gone, the wound can heal.
- Eat healthy. A healthy diet is important for good wound healing.
- Quit smoking. Smoking damages blood vessels, including the blood vessels in the leg.
- Prevent overweight.
- Avoid tight clothing, such as tight pants, elastic bands and the like.
- Ensure comfortable footwear. High heels hinder an effective pumping operation of the calf muscles.
- Put the legs up when sitting for long periods. If necessary, the foot end of the bed can be slightly raised, provided it doesn’t cause shortness of breath.