Leg ulcers are common — approximately 2% of adults will have a leg ulcer at some stage in their lives. Literally thousands of people develop a leg ulcer each year in the United Kingdom and many of those get more leg ulcers as the years go by. Despite the misery they cause, leg ulcers remain a neglected problem.
What is an ulcer? The medical definition of an ulcer is a break in the epithelium of a body surface or lining. Many of us will be familiar with a mouth ulcer. This is a break in the cell lining the mouth. It can be caused by an injury such as biting the inside of the mouth by accident. Well if the skin breaks down anywhere on the body it is called an ulcer. If the ulcer is on the leg and has been present for more than 6 weeks it is called a chronic leg ulcer.
Four out of 5 ulcers — that’s 80% – are caused by a problem with the leg vein pump and they are called venous ulcers. The leg vein pump is the mechanism by which blood flows out of the leg back to the heart. So problems with the deep veins such as obstruction from a deep vein thrombosis, superficial vein reflux or perforator vein problems can cause venous leg ulcers. The leg vein pump depends mainly on good ankle movement, good calf muscles and healthy leg veins. A minority of leg ulcers – about 15% – are caused by problems in the arteries that carry blood into the leg. An experienced doctor, nurse or clinician can correctly identify about 95% of venous leg ulcers by their appearance, by checking for pulses in the feet and by checking sensation. As most leg ulcers are venous — that’s what I am going to concentrate on.
Venous leg ulcers appear on the lower part of the leg usually just about the ankle. Often, there are varicose veins or thread veins around the ulcer and the leg is usually swollen. The skin is often thickened and discoloured by varicose eczema which may actually develop many months or years before the ulcer as a warning sign that the vein circulation is not normal.
Venous ulcers affect people who have deep vein problems, usually from a past deep vein thrombosis (DVT), people who have superficial venous disease or those with ankle mobility problems. Leg ulcers are more common as we get older. The aim of treatment is to get the ulcer healed as quickly as possible. This usually means graduated compression either with bandages or compression stockings. In most cases, antibiotics, creams and ointments are not necessary. Once the ulcer is healed it is very important to identify any problems with the superficial veins or perforator veins and that these are treated to reduce the risk of another ulcer. This means getting a full assessment with a duplex ultrasound scan.
Can you cure a leg ulcer? Well this is controversial. Some would say that if the problem is only in the superficial veins, the veins under the skin, or in the perforator veins that connect these superficial veins to the deep veins, then the ulcer can be cured. While there is good evidence that such treatment will greatly reduce the risks of getting another leg ulcer, if the skin has been very damaged and the ulcer has healed with a lot of scarring, this area of the leg may remain vulnerable and a trivial knock or injury might cause another skin breakdown even though the vein abnormality has been completely eradicated.
How can we avoid leg ulcers? Well there are 3 things I would suggest. Firstly, if you are unfortunate enough to suffer a deep vein thrombosis (DVT), it should be treated promptly to limit the damage to the deep veins. Unfortunately, damage to thedeep veins cannot be reliably reversed by surgery. So, prompt treatment with anticoagulants — blood thinning medication — reduces the extent of the clot and the damage to the deep veins. Secondly, if you have had a DVT, you should consider wearing good quality medical grade compression socks — some studies suggest that doing so may reduce the risk of leg ulcers after a big DVT. Thirdly, if you have superficial vein reflux have it treated early to reduce the chances of progression to varicose eczema which is itself a warning sign that the skin is damaged and liable to ulceration.
If you’re worried about your veins and would like a confidential chat please do get in touch. Our advisors are very happy to offer simple advice by telephone or email for free and without obligation. You can call and book an appointment with Nick or Simon direct without a referral from your GP.
The VeinCare Centre also offers a screening assessment with our vascular technologist. For £25 you can have a scan with Wendy Parsons. She is not a doctor and so she could not give you medical advice but she can check your deep veins and your varicose veins and give you an idea of how bad they are. If you would like to have an appointment with Wendy please call 01935 873 951