Leg Ulcer: Types, Causes, Symptoms, and Treatment

What Is a Leg Ulcer?

A leg ulcer is a chronic condition where a leg wound takes more than four to six weeks to heal. They usually develop on the inside of the leg, above the ankle. In most people, the wound normally heals within one to two weeks. But in patients with any underlying diseases, the skin does not heal in that area and the wound size increases, leading to a chronic leg ulcer.

What Causes Leg Ulcers and What Are Their Types?

Following are the different types of leg ulcers

• Venous Leg Ulcer: It is the most common leg ulcer, accounting for about 60 % of the cases. It is also called venous stasis ulcer. It occurs when a wound in the leg takes more than six weeks to heal due to vein and blood flow issues. The veins in the legs ensure the blood is flowing back to the heart. If the valves are damaged by thrombosis or blood clots, this backflow of blood is prevented and results in a pressure build-up in the veins. This increased blood pressure in veins can worsen the wound and make it difficult to heal. Venous ulcers usually form below the knee on the inner side of the ankle.

• Arterial Leg Ulcer: Arterial leg ulcers are due to poor blood circulation in the arteries. Damage to arteries results in poor blood flow to the lower extremities. Arterial ulcers usually occur on the outer side of the ankle or feet.

• Diabetic Leg Ulcer: It is a common complication in patients with uncontrolled diabetes. It occurs in areas of the foot with constant trauma and pressure sensations.

• Vasculitic Leg Ulcers: It is usually associated with chronic inflammatory diseases like rheumatoid arthritis and lupus erythematosus.

• Traumatic Leg Ulcer: It is a non-healing ulcer following an injury to the legs.

• Malignant Leg Ulcer: It is a leg ulcer associated with skin cancers that can result in malignant transformation.

• Other important factors that cause arterial leg ulcer includes:

  1. Age.

  2. Diabetes.

  3. Smoking.

  4. High blood pressure.

  5. High cholesterol level.

  6. Trauma.

  7. Thickening of arteries.

  8. Overweight.

What Are the Symptoms of Leg Ulcers?

About 80 % of leg ulcers are caused by venous diseases and show the following symptoms. Pain and swelling are common symptoms of leg ulcers. However, the symptoms can vary in venous and arterial leg ulcers.

Symptoms of Venous Leg Ulcer:

• Pain.

• Itching.

• Swelling.

• Hardening or discoloration of the skin.

• Foul-smelling discharge.

• Scabbing.

Symptoms of Arterial Leg Ulcer:

• Deep wound.

• Leg pain at night.

• No bleeding.

• Tight skin.

• Hairless skin.

• Red, yellow, or black sores.

• Affected area with minimal blood circulation and feels cold on touch.

• Leg turns red when hung freely and turns pale when elevated.

How are Leg Ulcer Diagnosed?

Doctors conduct physical examinations and carry out diagnostic tests to find the cause of the leg ulcer. In addition, various tests are also done to find the right treatment plan.

• Doppler Study: Doppler study is performed on arteries and veins in the leg to find the underlying cause of the ulcer. The decision to do a doppler study will be taken based on the appearance of the ulcer and other associated symptoms and risk factors. An ultrasound probe is placed on the top of the skin for a doppler study to see the blood flow patterns.

• Blood Pressure: The blood pressure readings at the ankles and arms are taken to compare.

• Computed Tomography (CT) Scan: It is a better diagnostic tool than X-rays. It helps to visualize the blood vessels and the ulcer itself using detailed cross-sectional images of the blood vessels. Bone changes can also be noted in the CT scans.

• MRI Scans: Uses radio waves to get a detailed picture of the affected area and can determine if the infection spreads to bone or deeper tissues.

How Are Leg Ulcers Treated?

Identifying the underlying cause of leg ulcers is an important step in the treatment process. Thus, ensuring ulcers are healed properly and will not recur. They are treated with proper care and administration of antibiotics.

Treatment for Venous Leg Ulcers: The venous leg ulcers are treated in two ways:

Steps to regulate the high pressure in the leg veins and treatment of the ulcer.

• Elevation of Limb: Keeping the legs elevated helps in reducing the blood pressure in the veins of the legs. Keeping legs elevated for about 6 inches all the time help sufficiently.

• Compression Bandages and Stockings: These are worn to reduce the blood pressure in the veins, especially while standing up. These compression socks or bandages provide tight support to reduce elevated blood pressure. Once the ulcers are healed, the compression bandages and stockings can be used to prevent the recurrence of ulcers.

• Dressings for the Ulcer: Proper dressing on the ulcer helps in healing. The dressings should be changed as per the doctor’s instructions. The wound should be cleaned thoroughly in between each dressing. Frequent cleaning and dressing prevent infection and allows leg ulcers to heal. It is best to change the dressing under the supervision of a nurse.

• Transparent Dressing: A clear plastic-like dressing is applied over the sore. A stocking is worn above the transparent dressing to keep it in place and to increase circulation.

• Hydrocolloid Dressing: It is a special type of bandage with a breathable outer layer and an inner layer to absorb drainage from leg ulcers, which aids in healing. This type of dressing also helps in removing dead skin and tissue.

• Medications: Prescribing antibiotics and painkillers.

• Graft Surgery: If the ulcers are non-healing for more than a year or longer, doctors suggest skin graft surgery to help wounds heal. Surgery on the veins can also be carried out. If the ulcer is due to varicose veins, surgical procedures is carried out once the ulcer is healed.

• Debridement: This surgical procedure removes dead and infected tissue from leg ulcers to help remaining tissues heal.

2. Treatment for Arterial Leg Ulcers:

• The first line of treatment includes restoration of blood circulation to the affected area.

• Prescription of antibiotics and other medications to relieve the symptoms

• Surgical procedures like angioplasty can be done to restore blood circulation.

• Arterial ulcers should be kept clean and dry and bandaged to prevent further infection.

How Can Leg Ulcers Be Prevented?

The main cause of leg ulcers is poor blood circulation. Therefore the first preventive step is to regulate the blood circulation in the legs.

• Control of conditions like diabetes, hypertension, and Raynaud’s disease.

• Staying healthy, regular exercise, and walking to help maintain good blood circulation.

• Decrease sodium intake.

• Quit smoking as risk of ulcers are increased.

• Use compression socks all day.

• Keeping the leg in an elevated position.

• Keep the skin healthy and hydrated and thereby preventing drying of the skin.

• Maintain a healthy weight and have a balanced diet.

Conclusion

A leg ulcer is a chronic condition where a wound takes more than four to six weeks to heal. Venous leg ulcers are common among leg ulcers. Major symptoms associated with leg ulcers are pain, swelling, itching, foul smell, pus discharge, and scabbing. Proper medical care should be provided for the ulcers to heal well. People with hard-to-heal ulcers may experience physical, mental, and social problems. Adequate care and support with proper steps to prevent relapse is equally important.