Venous Leg Ulcers: Types, Pictures and Treatment

• Painful wound on the shin or in the foot area
• Itchiness
• Swelling
• Change in skin colour on the extremity
• Feeling of heavy legs
• Signs of infection (fever, weakness)
• Unpleasant smelling fluid coming from the wound ^[1]

The primary cause of leg ulcer is vascular disease. Leg ulcers are not a disease in themselves, but a symptom of some other disease.

• 73% of leg ulcers are venous in origin. Professionally, venous ulcers are called ulcus cruris venosum.
• 8% of ulcers are related to artery disease. Doctors talk about an arterial ulcer – ulcus cruris arteriosum.
• 3% of leg ulcers are caused by diabetes.
• 2% of ulcers occur after trauma.
• 14% of ulcers have other causes. If there are several causes at the same time, it is ulcus cruris mixtum.^[5]

• Leg ulcers of venous origin
  It is caused by the accumulation of venous blood in the legs. It is a complication of chronic venous insufficiency. ^[6 ] Risk factors include a history of inflammation in the deep venous system, hereditary predisposition to venous disease, obesity, lack of exercise and sedentary occupation^[7].
  What do venous ulcers look like? They are usually smaller, shallow and have smooth edges. They are less painful than other types of leg ulcers. If patients report pain, it is usually related to the onset of inflammation. ^[8]
• Leg ulcer of arterial origin
  Arterial ulcers arise due to diseases of the arteries that affect the lower limbs. The main problem is the narrowing of the arteries. They occur more often in the elderly and in patients with high blood pressure.
  What do arterial ulcers look like? They are most commonly found on the heel, on the toes and around the ankle. Compared to other ulcers, they are deeper and have pronounced margins. Great soreness is typical, which intensifies at night when the legs are laid flat on the bed.^[9]
• Diabetic leg ulcer
  It is associated not only with diseases of the arteries and nerves on the peripheral parts of the body, but also with high blood sugar.^[10]
  What do leg ulcers look like in diabetes? They appear on the toes, on the soles of the feet and on the shins. The ulcers are not large, but they are deep and can extend to the bone. There is hardened skin around the ulcer.^[11] More on the diabetic foot diagnosis page.
• Other types of leg ulcers
  Leg ulcers can also be related to a number of other diseases. They occur, for example, in patients with rheumatoid arthritis (an autoimmune disease affecting the joints), in some cancers or in intestinal inflammation.^[12]
  

Seniors are at risk of developing leg ulcers, especially if they have diabetes, high blood pressure and are overweight. ^[13]
The risk also increases:

• deep vein thrombosis (a blood clot that clogs a vein),
• varicose veins on the legs,
• a previous fracture, injury or surgery to the leg that restricts walking and impairs blood flow.^[14]

If you suspect a leg ulcer, see a doctor as soon as possible. Without proper treatment, leg ulcers will not heal on their own. The doctor must determine the cause of their occurrence, otherwise the risk of worsening the condition or recurrence of ulcers increases.^[15]

How is the examination of leg ulcers carried out?

The first step is to find out information – so expect questions about the start of the problem, your general health and your employment. The doctor will then examine you carefully and determine further tests accordingly.

• The condition of the feet, location, size, shape and characteristics of the ulcers are determined by inspection. The doctor also monitors the possible appearance of varicose veins, swelling and skin color. All this is done standing and lying down.
• By palpation, the doctor assesses the temperature and tension of the skin, swelling and the characteristics of the ulcer itself.
• During the blood draw, blood count, blood sugar and other values are checked.
• In some cases, a tissue sample is taken from the leg ulcer for microbiological examination. ^[16]

• Up to 5% of people over the age of 70 suffer fromleg ulcers.
• The majority (80%) of ulcers are caused by vascular insufficiency.
• The most common complication of leg ulcers is infection. ^[18]

If a leg ulcer is not treated or the treatment is not effective, complications can occur with a significant impact on your life.

• Infection: an open wound resulting from a leg ulcers ulcer is a gateway for infection.
• Chronic pain: untreated can lead to permanent pain and limitations in daily life.
• Swelling and fever: Harmful microorganisms enter through an open wound and cause redness, swelling and fever.
• Rosacea: It is a bacterial infection of the skin.

Treatment of leg ulcers is carried out in several ways. Doctors from different disciplines work together.

Local treatment involves taking care of the ulcer itself, which must be cleaned and then treated with special preparations so that the wound can heal successfully. Dead tissue impedes healing, which is why its removal is so important.

The wound then requires the maintenance of a reasonably moist environment. This is helped by a number of modern means for so-called moist healing. ^[19]

Compression therapy belongs to the standard treatment of leg ulcers. It uses compression (tightening) elastic stockings or a bandage. The aim is to promote the proper functioning of blood circulation.^[20] The decision whether to use stockings or bandages depends on the stage of the disease, the condition of the lower limbs and the patient’s cooperation. In general, elastic bandages are used in the acute phase and tightening stockings in long-term treatment. Compression therapy is not used, for example, in patients with severe heart problems. ^[21]

The overall treatment of leg ulcers depends on what is causing them. Various drugs are used to treat vascular diseases, which counteract swelling, promote blood flow and have an anti-inflammatory effect. Patients also take medication for other conditions (such as diabetes). Pain killers are also sometimes needed and antibiotics in case of infection. ^[22][23]

Invasive treatment (surgery) comes into play when there is a need to improve blood circulation to the leg and to treat non-healing leg ulcers with vascular surgery. ^[24] Surgery for leg ulcers is performed at a specialised vascular surgery unit where different types of surgery are performed.

In home care for leg ulcer, various regimen measures and herbal products are used.

• Treat your body with substances called bioflavonoids. They are contained in, for example, blueberries, parsley, horseradish and red cabbage.
• Include rosehip tea in your drinking regime.
• Make sure your feet are warm and wear socks that don’t pinch. Both are important for maintaining good blood circulation. Poor blood circulation creates conditions for the development of leg ulcers.
• Poultices for leg ulcers can be prepared from horsetail or horsetail root. ^[26]

What to apply to leg ulcers? You can try ointment from calendula or marigold. These are herbs with healing effects.
Before you reach for herbs, whether in the form of teas or directly for wound care, consult your doctor. Caution is needed when using herbs, especially if you are taking medication.

However, grandmotherly advice for leg ulcers may not be effective as a full-fledged modern treatment, we always recommend visiting a specialist and discussing the treatment with him.

The best cure for legulcers is prevention. The following steps are important for her. They mainly concern at-risk groups and people who have had a history of leg ulcers.

• Follow the prescribed treatment for diseases that can cause leg ulcers (for example, diabetes or high blood pressure).
• Try to lose weight if you are overweight.
• Stop smoking cigarettes.
• Regularly engage in physical activities.
• Take care of your feet – prop them up when you sit at work and regularly give them a raised position at home.
• Ask your doctor how often to wear tightening stockings. ^[27][28]

Ask your doctor about spa treatment options for leg ulcers. It will tell you all the latest information and specific recommendations. Various special methods of ulcer care are used in the spa – for example, light therapy or electromagnets (magnetic therapy). ^[29][30]