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Leg ulcers: Causes, symptoms, diagnoses and measures for increasing healing time

  • Leg ulcers are a common occurrence across the globe and can arise from a number of causes. It is important to diagnose the correct classification of ulcer prior to treatment as a treatment for one type can be extremely damaging for another. The most common types of leg ulcers are venous due to venous insufficiency, arterial resulting from insufficient tissue perfusion, diabetic the result of peripheral vascular disease or neuropathy and rheumatic which is due to rheumatoid vasculitis. Leg ulcers can also be mixed caused by a combination of arterial and venous problems. In the UK, for example, venous is the most common type of leg ulcer accounting for over 90% of leg ulcers.

    Therefore, let's focus on venous leg ulcers. This post is not instead of medical advice but is a tool to help you understand more about your venous leg ulcer, reduce the risk factors and things you can do to aid healing.

    Risk factors

    There are a vast number of risk factors for the development of venous leg ulcers. Obesity can lead to vein damage through hypertension. Long-term immobility from a stroke or injury may cause muscular weakening affecting venous return. Deep vein thrombosis (DVT) can occlude a vein and reduce tissue perfusion, and varicose veins indicate valve incompetence. There is commonly a history of leg injury in approximately half of the patients with chronic venous insufficiency. Lifestyle factors such as smoking or having a job that requires you to stand for long periods can also increase your risk.

    All of these factors can cause damage to the valves or flow of blood in the superficial veins in the lower legs. The flow of blood back from your legs, to your heart, relies on the integrity of passive valves in the veins to prevent the backflow of blood towards the lower leg due to gravity and pressure changes within the vascular system. Failure of these systems results in chronic venous hypertension, a long-term increase in ambulatory venous pressure. Chronic venous hypertension causes stretching of the venous and capillary walls in the affected areas allowing fluid and proteins to leak into the interstitial tissue, resulting in tissue damage and potentially a venous leg ulcer.

    Signs of a venous leg ulcer

    Patients with chronic venous hypertension present with limb pain which is commonly relieved by elevation. Relieving of this pain by elevation can be a sign that your ulcer is that of a venous origin but not all people have this indicating factor.

    Pitting oedema is normally another sign due to the fluid that has leaked from the veins into the surrounding tissue. It worsens typically as the day progresses and reduced when you get into bed and lie flat.

    Ankle flare is sometimes evident which is where the skin is stained brown around the ankles. This is caused by dilation of superficial veins at the bottom of the leg. The skin may be stained brown by haemosiderosis from haemoglobin breakdown in red cells which have leaked into the tissues.

    Typically, a venous ulcer develops near medial or lateral malleolus (inside and outside ankle area) and develops slowly if untreated.

    Venous leg ulcers usually are shallow in appearance and granulating tissue may be seen. It is also moist as fluid from the surrounding tissue seeps out.

    Related: Everything you need to know about hypertension

    Diagnoses

    Clinical history, visual assessment and laboratory tests are required to find the aetiology and associated diseases to diagnose, manage and refer for further investigations. Lack of adequate clinical assessment resulted in ineffective and inappropriate treatment.

    It is highly recommended that a Doppler measurement of ankle/brachial pressure index (ABPI) should be used to screen for arterial disease as applying compression to a patent with arterial insufficiency could result in limb ischaemia, pressure damage and loss of limb. The ABPI of a venous ulcer patient normally exceeds 0.8.

    How you can increase the healing time

    Smoking increases your risk factors for developing a venous leg ulcer however it also removes and decreases the absorption of vitamin C which is required for protein and collagen formation. By stopping smoking, not only do you reduce the risk of developing an ulcer, but you can also increase the speed the ulcer heals.

    A balanced diet is required for wound healing. It should contain proteins for tissue construction, carbohydrates to provide the energy, fats to regenerate tissue and for energy, vitamins and trace elements.

    In addition to eating a balanced diet, if you are obese then losing weight will really help the healing of your venous leg ulcers.

    Applying compression bandaging or hosiery is essential in the treatment of venous leg ulcers. However, it is important to have a correct diagnosis as can be detrimental for the treatment of arterial leg ulcers. Its effect is to reduce superficial venous system blood pressure and increase blood flow in deep veins by encouraging venous return. Compression bandaging should only be applied by a trained member of your healthcare team, and past medical history needs to be carefully looked at.

    As the cause of venous leg ulcers is due to the lack of blood flow back from your legs, then there is one major thing that you can do to help this than by elevating your legs when sitting in a chair. It will significantly improve the blood flow back to your heart. 

    Hopefully, this post will have helped you a little bit more into understanding how venous leg ulcers happen, how you can reduce your risk of contracting them and steps you can follow to aid your healing. With proper wound treatment and by taking these extra steps, you can work together with your health care professional to maintain and heal your leg ulcer.

    Read the next article about arterial leg ulcer, its risk factors, symptoms, diagnoses and procedures for healing.

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