What Questions Should I Ask My Healthcare Provider
You may want to ask your healthcare provider:
- What caused the leg ulcer?
- What is the best treatment for me?
- What changes can I make to heal the wound and prevent future ulcers?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Leg ulcers can be painful, unsightly and difficult to treat. Chronic leg ulcers need specialized wound care to prevent infection and aid healing. Your healthcare provider may recommend other treatments like medicines or procedures to improve blood flow to the leg. Even after they heal, leg ulcers can break open again. Your provider can offer suggestions on how to prevent a wound recurrence.
Last reviewed by a Cleveland Clinic medical professional on 06/23/2022.
How Are Leg Ulcers Diagnosed
A vascular specialist a healthcare provider specializing in the circulatory system and knowledgeable about wound care can examine the ulcer. Your provider will examine your skin and the wound.
You may also get:
- Ankle-brachial index test, which uses ultrasound technology to measure blood pressure and blood flow in the legs.
- Biopsy to check skin cells and fluid from the wound for infections and skin diseases.
What Are Leg Ulcer Treatment Options
A screening can help your doctor understand how severe your condition is and suggest a treatment plan that fits your needs. At Precision Vascular, we are happy to offer the following diagnostics and treatments that promote healing and resolve the root cause of why you have leg ulcers.
- Diagnostic Arterial Ultrasound This is a non-invasive, non-surgical procedure that takes 45 minutes to an hour to complete. It can safely diagnose the health of a patients arteries, blood vessels, and cardiovascular system.
- Diagnostic Angiography This is a type of X-ray used to check blood vessels. A special dye is first injected into your blood. This highlights the blood vessels, allowing your doctor to see any problems. This diagnostic test creates advanced x-ray images called angiograms.
- Angioplasty Your vascular specialist will use a balloon system to open up narrowed or blocked arteries. A catheter is inserted through a small incision and advanced to the affected artery. There is minimal downtime.
- Atherectomy This procedure uses advanced laser technology to erase plaque buildup in the arteries. It can be performed on its own but is often combined with angioplasty and stenting.
- Stenting A more advanced procedure, this involves using a small mesh tube to keep a closed-off blood vessel or artery open for the long term. This procedure greatly reduces the chance of a reoccurring blockage.
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Cleaning And Dressing The Ulcer
The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This provides the best conditions for the ulcer to heal.
A simple, non-sticky dressing will be used to dress your ulcer. This usually needs to be changed once a week. Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.
What Causes Leg Ulcers
Causes of leg ulcers include:
- Chronic venous insufficiency: Chronic venous insufficiency occurs when faulty valves in leg veins allow blood to flow backward into the leg where it pools. If you develop high blood pressure in the leg veins, tiny blood vessels can burst, causing inflammation, itching and dry skin. Leg ulcers develop when the skin breaks open.
- Diabetes: High blood sugar levels from diabetes can cause fat deposits to form inside blood vessels, causing them to narrow. Reduced blood flow can cause nerve damage or diabetic neuropathy. With these nerve problems, you may not be able to feel a leg ulcer or know its there. Diabetes also slows the wound healing process.
- Peripheral artery disease : This condition causes plaque to build up in the arteries . The blood vessels in the leg become narrow, leading to poor blood circulation. The reduced blood flow slows the healing of leg ulcers. People with diabetes are more likely to develop PAD.
- High blood pressure: Chronic, poorly controlled high blood pressure can cause an extremely painful ulcer on the lower leg called a Martorell ulcer. High blood pressure causes the capillaries in the skin to become narrow, cutting off the blood supply to the skin. The skin can die, forming a leg ulcer.
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My Dog Has A Sore That Wont Heal What Do I Do
All sores look different, but youâll likely know it when you see it. On your dog, itâll typically look like bumps that are red and itchy. A dogâs sore has to be dealt with quickly to spare your dog some pain and give them the best chance of healing soon. If you notice your dogâs sore isnât healing, here are a few things you can do to help the healing process along and give your pup some comfort. However, if it looks serious you should contact your veterinarian immediately and get their advice on what to do.
Give your dog the best care at home with Fauna Care healing sprays. Theyâre easy to apply and help heal minor cuts and burns. This article covers:
High Blood Sugar Or Diabetes
Diabetes is the root cause of many wounds that wont heal because it directly damages the bodys natural healing process.
If you have healthy, balanced blood sugar, any wound on your body triggers a natural response of blood flow, clotting, and scabbing. This process protects your underlying tissues from bacteria and fights infection. Your nearby blood vessels also jump into action to deliver fresh oxygen and nutrients to the wound, which gives powerful white blood cells the opportunity to support rapid wound healing.
This natural response becomes far more difficult if you have diabetes or uncontrolled high blood sugar. Extremely high levels of sugar in the blood impair the function of white blood cells, which in turn stunts the bodys ability to ward off bacteria. As a result, diabetics are more prone to sudden infections and wounds that wont heal.
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About Venous Leg Ulcers
A leg ulcer is a long-lasting sore that takes more than 4 to 6 weeks to heal. They usually develop on the inside of the leg, just above the ankle.
The symptoms of a venous leg ulcer include pain, itching and swelling in the affected leg. There may also be discoloured or hardened skin around the ulcer, and the sore may produce a foul-smelling discharge.
See your GP if you think you have a leg ulcer, as it will need specialist treatment to help it heal.
Your GP will examine your leg and may carry out additional tests to rule out other conditions.
Read more about how a venous leg ulcer is diagnosed.
Treatment What Treatment Will I Be Offered For My Leg Ulcer
If your wound isnt healing because of venous hypertension and there are no problems with the blood supply to your legs, then you should be offered compression therapy.
Compression therapy improves blood supply by applying pressure to the leg. This can be done by bandaging the lower leg or by wearing supportive socks, stockings or tights. Compression therapy is very effective at reducing swelling, improving blood flow in the veins and healing or preventing sores or ulcers.
There are lots of different types of compression therapy so ask your nurse to find something that is right for you.
Compression can be a little uncomfortable when you first start treatment but should not cause you any pain. Any discomfort should reduce as the swelling goes down. If you do experience discomfort, talk to your nurse or doctor about it and they will advise you on ways of alleviating this.
In addition to the compression, your nurse should also advise you on wound care and dressings to keep your wound healthy.
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Healthcare Advice For Leg Ulcers
There are some lifestyle changes you can make that will help boost healing:
- Maintain a healthy weight
- Eat a well-balanced diet that includes 5 portions of fruit and vegetables a day and protein rich foods such as eggs, fish, chicken or pulses
- Take light to moderate exercise such as cycling or walking for about thirty minutes at least three times a week
- Avoid standing or sitting for long periods of time
- Put your feet up elevate your legs above your heart.
- Every so often, move your feet around in circles, then up and down. This helps blood circulate and get back to your heart
A Mole That Has Significantly Changed In Appearance
If you notice that any mole that has changed color or if it has become larger, it could possibly be a sign of skin cancer. So, be sure to get any mole that has changed in size, shape, or color checked. Also, another warning sign to look out for is a mole that has multiple or unusual colors like red, white, blue, or black.
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Caring For Venous Ulcers
Venous ulcers need proper care and treatment to prevent infection and to heal. It’s important to have any venous ulcers checked right away by your healthcare provider.
Treatment may require focusing on the circulatory or vein problems that are causing the ulcers. Or it may mean removing some tissue around the wound. You may be asked to:
Clean the wound regularly
Apply a dressing to the ulcer
Avoid products that cause skin sensitivity
Wear compression stockings to prevent blood from pooling in the legs and to speed healing
Apply an antibacterial ointment or another topical medicine to prevent or treat an infection
Take oral antibiotic medicines to prevent or treat an infection
Have allergy testing done
Wearing a compression wrap to keep blood flowing back up to your heart can also help ulcers heal more quickly. In some cases, surgery or a skin graft is needed to close up the opening in the skin.
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- A skin wound that fails to heal, heals slowly or heals but tends to recur is known as a chronic wound.
- The treatment recommended by your doctor depends on your age, health and nature of your wound.
- Contrary to popular belief, chronic wounds are more likely to heal if they are treated with moist rather than dry dressings.
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What Causes Open Sores On Legs
Open sores on leg which do not heal are usually caused by vascular diseases, diabetes, certain infections such as leprosy, and skin cancer. Non healing open ulcers can be categorized into various types such as:
Pressure sores, vascular sores, diabetic sores, marjolins ulcer, ulcers due to infective organisms, pyoderma gangrenosum.
How Is Venous Insufficiency Diagnosed
Your doctor will want to do a physical examination and take a complete medical history to figure out if you have venous insufficiency. They may also order some imaging tests to pinpoint the source of the problem. These tests may include a venogram or a duplex ultrasound.
Venogram. Your doctor will put an intravenous contrast dye into your veins. Contrast dye causes the blood vessels to appear opaque on the X-ray image, which helps the doctor see them on the image. This dye will provide your doctor with a clearer x-ray picture of your blood vessels.
Duplex ultrasound. A type of test called a duplex ultrasound may be used to test the speed and direction of blood flow in the veins. A technician will place gel on the skin and then press a small hand-held device against your skin. The transducer uses sound waves that bounce back to a computer and produce the images of blood flow.
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Referral To A Specialist
In some cases, your GP or nurse may decide to refer you to a specialist in conditions affecting the blood vessels .
For example, you may be referred to a vascular specialist if your GP or nurse is unsure about your diagnosis, or if they suspect your ulcer may be caused by artery diseases, diabetes or rheumatoid arthritis.
After taking your medical history and examining you, the vascular specialist may need to arrange further investigations to plan your treatment.
What Is Venous Insufficiency
Your veins are responsible for carrying blood back to the heart. The valves in your veins stop the blood from improperly flowing backward. When your veins are having trouble sending blood to your limbs, venous insufficiency develops. This occurs when your blood cannot flow properly to the heart, which causes blood to pool in the legs. This can cause your leg ulcers to worsen without proper treatment from Dr. Ranjan. Untreated diabetes can also lead to deep leg ulcers.
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What Can Cause Leg Ulcers
Venous hypertension / insufficiency the most common cause of poor healing on the lower leg is venous hypertension. This is when the veins struggle to take the blood back up the leg, so the blood can pool at the ankle creating pressure in your veins
Peripheral arterial disease another reason why our lower leg wound might not be healing is because not enough blood is getting down to our feet to heal the wound. This is then the opposite of the problem described above with veins.
Diabetes peripheral arterial disease is a known complication of diabetes, which can lead to developing a leg ulcer or diabetic foot ulcer.
Getting Diagnosed With A Leg Ulcer
If you have a wound or sore that isnt healing, make an appointment at your GP practice as it could turn into or be the beginnings of a leg ulcer. You might be given an appointment to see the nurse rather than the doctor as nurses are often responsible for caring for patients with leg problems.
Alternatively, there might be a Leg Club or specialist leg clinic in your area. You can attend these without having to be referred by your GP.
Remember to remove any nail polish from your toenails before your appointment.
When you see the nurse or doctor, they should:
- Ask about your symptoms and how long you have had problems
- Examine your lower legs
- Do a simple test called a Doppler ultrasound. This test compares blood flow in your ankle with that in your arm to find out if there are blood flow problems in your lower leg. You may have to come back to have your Doppler test on another day or at another clinic.
You may also be offered some other tests to check for other health problems that can affect your legs such as diabetes and anaemia.
If your GP practice thinks you have problems with your veins or arteries, they may refer you for more tests at your local hospital or specialist clinic.
You may hear different words to describe your wound such as ulcer, leg ulcer, sore, laceration, chronic wound and maybe others. Ask your nurse to explain their choice of word and what this may mean for you.
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Venous Hypertension / Insufficiency
The most common cause of poor healing on the lower leg is venous hypertension. You may also hear it referred to as venous insufficiency, venous reflux or venous disease. Venous means anything related to our veins. Blood is pumped from our heart to the rest of our body through our arteries and returns to our heart through our veins. It is then propelled back to our heart by our heart pumping. Our leg and foot muscles help this along by circulating blood as we walk and move our ankles. This is why standing a lot or sitting with our legs down for long periods may stop a wound from healing.
Our veins contain one-way valves to stop the blood falling back towards your feet. These valves can become weak or damaged. When this happens, our veins become so swollen that blood is forced into the tissue of your skin. This makes our skin swollen, fragile and unable to heal as normal.
You might also notice that your ankles are swollen, that there is brown staining on your legs or that your wound is leaking.
To help our veins work better and to control any swelling, compression therapy is an essential part of any treatment plan.
Consult A Wound Care Specialist
Wound care specialists are specially trained in advanced wound care techniques and will utilize wound care treatments that standard doctors arent trained or qualified to perform. They will evaluate your individual situation and recommend the optimal specialized treatment plan and procedures for you.
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Do You Have Sores And Wounds On Your Legs That Just Wont Heal
Damaged veins in the legs allow blood to pool in the calf, ankle and foot instead of efficiently flowing back to the heart. This causes pressure to build in the surrounding vessels and tissues, preventing the flow of good oxygen and nutrition.
Over time, this starves and suffocates the skin and underlying tissue, causing it to begin to die. This can lead to an open skin ulcer, and can also prevent even simple injuries to the leg from healing normally. If the underlying cause, venous reflux, is not addressed this chronic, progressive disease process can greatly impact your quality of life.
Looking After Yourself During Treatment
To help your ulcer heal more quickly, follow the advice below:
- Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse
- Whenever you’re sitting or lying down, keep your affected leg elevated with your toes level with your eyes
- Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation
- If you’re overweight, try to reduce your weight with a healthy diet and regular exercise
Read more about preventing venous leg ulcers.
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