Leg ulcers

Also called Venous leg ulcer, Chronic wound

Most are caused by veins, not by the injury that seems to have started them, and most heal with compression. Getting compression on is the whole treatment.

What it is

An open wound on the lower leg that has not healed within two weeks. Around eight in ten are venous: the valves in the leg veins have failed, pressure builds in the skin, and the skin breaks down and will not close.

The knock that appeared to cause it is usually incidental. The underlying problem was there for years, showing as swollen ankles, brown staining and hard, tight skin around the ankle.

Compression is the treatment. Strong, correctly applied compression heals most venous ulcers, and nothing else on offer comes close. Dressings do not heal them; they manage the surface while compression does the work.

The catch is that compression is dangerous if the arteries are also narrowed, so an assessment comparing blood pressure at the ankle and the arm has to come first. See peripheral arterial disease.

People with diabetes get a different kind of ulcer, on the foot and driven by pressure and neuropathy, which is managed differently and more urgently. See podiatry.

Signs you might notice

An open area on the lower leg, often above the ankle, with irregular edges and a shallow base.

Before it opens: swollen ankles, itchy dry skin, brown or purple staining, and skin that feels hard.

Pain, often worse when the leg hangs down and better when it is raised, which is the opposite of arterial pain.

Signs of infection needing same-day help: spreading redness, increasing pain, heat, fever, or a sudden change in smell or amount of fluid. See cellulitis and sepsis.

Any ulcer on the foot of somebody with diabetes is urgent, whatever it looks like.

How it can affect day-to-day life

The smell and the leakage are what people find hardest, and they are why somebody stops going out, stops seeing friends and stops wearing what they want to wear. It is a wound that isolates.

Compression is uncomfortable at first and many people take it off. Reduced or abandoned compression is the main reason ulcers do not heal, and the reason is almost always pain, heat, or bandages applied badly rather than unwillingness.

Healing takes months, and recurrence is common. Compression hosiery after healing is what prevents the next one, and stopping it is what causes the next one.

Living with an unhealed wound for a year is genuinely depressing, and low mood in this group is under-treated.

Supporting someone well

Any leg wound not healing in two weeks should be assessed properly, including the arterial check. Do not let it drift as a dressing change.

Ask for a leg ulcer service or a tissue viability nurse rather than repeated appointments for a new dressing.

Get compression on, and if it is unbearable, say so and ask for it to be adjusted. There are several systems and some suit people far better than others.

Elevate the legs above hip height when sitting, and keep walking. Walking works the calf muscle pump, which is what moves the blood.

Moisturise the whole lower leg daily, avoiding the wound itself.

Keep the compression hosiery going after healing. This is the prevention.

Learn the infection signs above, and get them seen the same day.

Where to get help

A GP practice or the community nursing team, asking specifically for a leg ulcer assessment including ankle and arm blood pressure comparison.

Same-day help for spreading redness, fever or sudden increased pain.

Legs Matter have the clearest patient information on compression and on how to challenge care that is not working.