What is a leg ulcer?
A leg ulcer is simply a break in the skin of the leg, which allows air and bacteria to get into the underlying tissue. This is usually caused by an injury, often a minor one that breaks the skin.
In most people such an injury will heal up without difficulty within a week or two. However, when there is an underlying problem the skin does not heal and the area of breakdown can increase in size. This is a chronic leg ulcer.
Venous Leg Ulcer
What causes leg ulcers?
The most common underlying problem causing chronic leg ulcers is disease of the veins of the leg. Venous disease is the main reason for over two thirds of all leg ulcers.
- Venous Disease (caused by veins not working) – about 80% of leg ulcers
- Arterial Disease (caused by the arteries not working) – about 15% of leg ulcers
- Other causes (includes diabetes and rheumatoid arthritis as well as some rare conditions) – about 5% of leg ulcers
In some cases two or more conditions may be causing damage at the same time. Your doctor will examine you and do some tests to see what sort of ulcer you have. The following advice applies to venous ulcers and may not be appropriate for other sorts of ulcers.
How does venous disease cause ulcers?
The veins in your leg are tubes that carry the blood back from the foot towards your heart. The veins in your legs have one-way valves that make sure the blood flows up the leg and not back down. In some people, these valves are not very effective or can be damaged by thrombosis (clots) in the veins. If the valves are damaged, blood can flow the wrong way down the veins, which results in a very high pressure in the veins when standing up. This abnormally high pressure in the veins damages the skin and leads to the ulcers.
How will I be treated?
Treatment of a venous leg ulcer happens in two ways:
- Controlling the high pressure in the leg veins
- Treatment of the ulcer
The mainstays of treatment are compression bandaging or stockings and elevation of the limb:
Elevation of the limb
The higher the leg, the lower the pressure in the leg veins. If the foot is elevated above the heart then the pressure in the foot drops to a normal level. Put your legs up whenever you can and as high as you are able-the arm of the sofa is good. Elevate the lower end of your bed (6 inches or so) so that when in bed your feet are a little higher than your head. You can use some old books for this.
Compression bandaging or stockings
In order to keep the pressure in the leg veins at the ankle low when you are standing up, you will be treated with compression bandaging or stockings. Several layers of bandages may be required to get the necessary pressure to control the veins. Once the ulcer is healed, compression stockings are usually necessary to prevent the ulcer from returning. These stockings need to be specially fitted and are much stronger than ordinary “support tights”. If you have difficulty putting on your stockings then you can buy a special stocking applicator.
Risk Factors
There are a number of reasons why venous leg ulcers occur. Physicians refer to these causes as risk factors. As people age, vein issues become more common. Small problems that started earlier often progress into larger ones
Other risk factors include:
Family History
- If you have immediate family members who have vein problems, chances are that you may develop them as well. Vein disorders are hereditary.
- Inherited factors related to blood clots or clotting disorders are also important, as you could also have inherited the same clotting disorder.
Trauma
- Soft tissue injuries can often result in the onset of swelling due to damage of the venous or lymphatic drainage.
- This can happen as a result of an impact injury, such as getting hit with a ball or another hard object. Trauma can subsequently lead to thrombosis. Varicose veins in that area of your leg may appear.
- The damaged veins may not be evident for some time.
- Post-surgical patients carry risks for blood clots, often due to inactivity or immobility.
- Skin changes may be due to chronic fluid or swelling in the damaged area.
Medications
- Female hormones such as estrogen and progesterone can increase risk factors for venous disease.
- The most common medications to do this include oral contraceptives (birth control pills), hormone replacement therapy, and infertility drugs.
Pregnancy
- Progesterone levels remain very high during pregnancy.
- Progesterone relaxes the muscle in the vein walls, allowing them to stretch.
- The physiologic changes that a woman undergoes during pregnancy place her at risk for the development of spider and varicose veins, which worsen with age.
Occupation
- Standing or sitting for long periods of time can worsen venous ulcers.
- Teachers, nurses, flight attendants, hairstylists, sales clerks, etc., are very prone to developing venous skin changes, including ulcerations as depicted in the photos above.
- An underlying venous problem likely is present when ulcerations are evident. The precise ulcer location and skin changes are highly suggestive of impaired venous circulation. This can be mechanical or physiological. Professional medical advice is recommended.
Other Medical History
- The presence of skin ulcers, such as the changes depicted in photos above, is the most severe form of venous problems. Other concomitant diseases, including heart disease, kidney disease, venous obstruction/blockage, or other medical problems may be associated with lower extremity skin changes. Professional medical advice is highly recommended and necessary.
- People often assume that weight is a risk factor in venous disease. While many patients find that they feel better when they maintain a healthy weight, the actual influence of weight on the development of ulceration is not clearly known.
- A risk factor likely exists in patients who are grossly overweight.
- Gait: how we walk is critical to movement of the blood. It is important to have the blood pumped through the veins by activating our calf muscles. This can be facilitated by fully flexing the ankle, known as dorsiflexion. Individuals with orthopedic impairment may be at greater risk of developing venous blood impairment. Patients likely will develop venous symptoms and venous insufficiency.
- Blood clots: often familial but a very important risk factor for venous disease.
- Poor nutrition is often a factor to skin ulceration.
Treatment of Varicose Ulcers
Dr. Carullo of Las Vegas Vein Center offers an integrated approach in the treatment of varicose ulcer. The treatment of venous ulcers needs to focus on both the short term and long term situations.
Dr. Carullo focuses on the healing of the ulceration and offers solutions to prevent future problems and ulcer recurrance.
Treating the underlying varicose veins, venous insufficiency and venous reflux will help stop the primary cause of the problem.
It is critical to seek the help of a clinic and doctor highly experienced in evaluating / diagnosing and treating these chronic wounds. Call Las Vegas Vein Center now at (702)852-2020 or complete the form on this web page and we will be in contact by phone or return email quickly to answer your questions or schedule an evaluation.
