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1. What is a leg ulcer?
A leg ulcer is simply a break in the skin of the leg. The immediate cause is usually an injury, often a minor one that breaks the skin. In most people such an injury will heal up without difficulty within a week or two. However, if there is an underlying problem the skin does not heal and the area of breakdown may even increase in size. This is a chronic leg ulcer.
2. What causes leg ulcers?
The most common underlying problem causing chronic leg ulcers is disease of the veins of the leg. Venous disease is the main reason for over two thirds of all leg ulcers. There are less common causes for leg ulcers such as disease of the arteries, diabetes or rheumatoid arthritis as well as a number of even rarer conditions. In some cases two or more conditions may be causing damage at the same time. Your doctor will examine you and do some tests to see what sort of ulcer you have. Usually, the blood pressure in your legs will be checked to ensure the blood supply is normal and an ultrasound scan (Duplex) of the veins (and sometimes the arteries) will be performed to assess their function. The following advice applies to venous ulcers and may not be appropriate for other sorts of ulcers.
3. How does venous disease cause ulcers?
The veins in your leg are tubes that carry the blood back from the foot towards your heart. The legs contain one-way valves that should allow flow up the leg and not back down the leg. However, these valves are not very effective in some people or can be damaged by thrombosis (clots) in the veins. If the valves are damaged, blood can flow the wrong way down the veins, which results in a very high pressure in the veins when standing up. This abnormally high pressure in the veins damages the skin and leads to the ulcers.
4. How will I be treated?
Treatment of a venous leg ulcer is aimed firstly at controlling the high pressure in the leg veins and secondly at the ulcer itself. The mainstays of treatment are compression bandaging or stockings and elevation of the limb:
Elevation of the limb. The higher the leg, the lower the pressure in the leg veins! If the foot is elevated above the heart then the pressure in the foot drops to a normal level.
Put your legs up whenever you can and as high as you are able-the arm of the sofa is good.
Elevate the lower end of your bed (6 inches or so) so that when in bed your feet are a little higher than your head. You can use some old books for this.
Compression bandaging or stockings. In order to keep the pressure in the leg veins at the ankle low when you are standing up, you will be treated with compression bandaging or stockings. Several layers of bandages may be required to get the necessary pressure to control the veins. Once the ulcer is healed, compression stockings are usually necessary to prevent the ulcer from returning. These stockings need to be specially fitted and are much stronger than ordinary "support tights". If you have difficulty putting on your stockings then you can buy a special stocking applicator. Usually, Class 2 knee length stockings are advised. They should be worn during the day and renewed every three months.
Dressings. The nurse will use a number of different dressings under the bandages depending on the state of the ulcer itself. These dressings may well change as the ulcer progresses. However, a simple non-adherent dressing is often best in order to prevent an allergy developing due to continuous use of more elaborate dressings.
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