What are leg ulcers?
An ulcer is a break in the surface of the skin that takes a long time to heal (more than six weeks or so). Leg ulcers usually follow an injury, such as knocking or scratching your leg.
Ulcers usually affect the inside of the lower leg around the ankle but you can get them on the outside of your leg or on the top part of your foot.
What causes leg ulcers?
Leg ulcers are more likely to occur in older people due to poor circulation. People who develop ulcers have high pressure in the veins in their legs. Usually the pressure is high because the veins have been damaged or because the valves in the veins aren't working properly. In many cases the damage is the result of an earlier thrombosis (clot) in the leg.
Poor circulation can cause your ankles to swell and lead to a condition called varicose eczema. This can make the skin on your lower leg turn brown or purple. The eczema can be itchy but rubbing and scratching the skin will aggravate the eczema and may also cause ulcers to form.
Being overweight, spending long periods in bed or prolonged inactivity can also make ulcers more likely to develop.
What problems do leg ulcers cause?
One of the main problems with leg ulcers is that they can be very slow to heal. They are generally painless unless they become infected (all ulcers are at risk of becoming infected). However, the leg may become swollen and feel quite uncomfortable. There is an uncommon, painful type of ulcer which can be caused if an artery in the leg becomes blocked.
An untreated ulcer can get larger, increasing from a small cut in the skin to a large wound measuring several inches across.
How are leg ulcers treated?
The most important aspect of treatment is to reduce the high pressure in the leg veins. To start with treatment will involve a type of bandaging that compresses your leg and improves your circulation. Your practice nurse or your doctor will apply the bandage - they will need to check the circulation in your legs before applying the bandages.
The ulcer needs to be cleaned regularly with sterile salt solutions and your nurse will put on special dressings to keep the ulcer clean and help it to heal.
Your nurse will treat any infection by careful cleaning of the wound. Your doctor may prescribe antibiotics.
If the ulcer does not heal your doctor may refer you to a hospital specialist. It is possible you may need admission to hospital for closer observation of the ulcer. In very rare cases an operation to improve the circulation or plastic surgery to cover the ulcer with new skin can speed up the healing process.
Preventing another leg ulcer
Once your ulcer has healed the most important way of preventing another one occurring is to wear compression stockings, which need to be fitted by your pharmacist. You will need to wear these continually during the day for as long as your GP advises. Compression stockings are designed to look the same as ordinary stockings or tights and come in a range of colours.
It is also vital to protect your legs from injury as far as possible.
Good health, regular exercise, a healthy diet with vitamin supplements, and stopping smoking all help to prevent leg ulcers.
Help yourself
- Put your compression stockings on before you get out of bed to prevent your legs swelling during the day
- Always wear compression hosiery during the day to prevent the ulcer coming back
- Take regular gentle exercise to improve the circulation in your legs
- Elevate the foot of your bed so that your legs are above the level of your heart to reduce swelling (don't put pillows under the back of your legs - this can restrict circulation)
- Put your feet up! Avoid sitting for long periods with your legs down to prevent swelling and help circulation
- Use a moisturising cream on your legs and feet every day to keep your skin in good condition
- Tell your practice nurse or doctor straight away about any cuts or sores on your legs
Further information available from:
Tissue Viability Society
21 Wilson Street
Cardiff CF24 2NZ
Internet: www.tvs.org.uk
Fact sheet provided by MIMS
Date last reviewed: November 2008
