Venous leg ulcers Kōmaoa waewae

Venous leg ulcers develop because of problems with faulty valves in your leg veins. Valves in your legs help to push blood from your legs and feet back up towards your heart. If these valves become damaged, the blood pools in your leg veins, causing increased pressure and skin changes.

Often an ulcer will develop after a minor injury to your leg, and because the problems with your veins, the wound fails to heal.

You are more at risk of developing a venous leg ulcer if you:

• are overweight
• have a history of varicose veins
• have limited mobility
• have a history of deep vein thrombosis (DVT)
• have had a previous venous leg ulcer
• are aged over 60.

The most common symptom of a venous leg ulcer is a wound that:

• does not heal in the expected time
• is irregularly shaped with dry, hard skin around the outside.

It develops below your knee, usually on the inside of your lower leg above your ankle.

Other symptoms include:

• swelling, especially around the ankle of your affected leg
• aching legs
• pain
• clear discharge.

Venous leg ulcers are at risk of becoming infected because they are slow to heal. Signs of an infected leg ulcer include:

• increased pain
• green, smelly discharge
• developing a temperature
• an increase in swelling and redness around the wound.

 If you notice any of these symptoms you should see your healthcare provider as soon as possible.

A venous leg ulcer is usually diagnosed based on:

• what it looks like
• how long it has been there
• your medical history and other risk factors.

Your healthcare provider may organise other tests to check your circulation before starting treatment.

The main treatment for venous ulcers is compression therapy with special pressure bandaging.

Compression therapy applies pressure to your affected leg, which reduces the amount of blood pooling in your veins and helps to redirect the blood flow to your heart. It can help to reduce the swelling and encourages oxygen and nutrients to be delivered the wound, which are critical for healing.

The wound will need care including:

• removal of dead tissue (debridement )
• treatment for venous eczema with topical steroids and emollients (moisturisers).

Venous eczema is a type of eczema that can happen when you have poor blood flow from your legs back up to your heart (venous insufficiency).

A district nurse who is specifically trained to manage leg ulcers will usually do the treatment.

It usually takes several months of treatment to heal your ulcer. If your ulcer is not healing, you may be referred to a specialist wound clinic or vascular surgeon.

You can help your ulcer heal and reduce the chance of getting another.

• Keep active by walking as much as you can and avoid standing for long periods.
• Raise your leg as close to your hip level as possible when sitting. In bed, place a pillow under your calf.
• Eat well, drink plenty or fluids and aim for a healthy weight.
• Look after your skin using moisturiser regularly.
• Stop smoking if you smoke.

Compression stockings

After your ulcer is healed your district nurse or specialist wound care team is likely to recommend you wear compression stockings. They will arrange to have these specially fitted for you.

You should put on compression stockings when you first get up and remove them before going to bed.

If you find it difficult to put them on or remove them, you might need a whānau member or carer to help you. You may also find a compression sock aid helpful. You can buy these online.

The stockings needs to be replaced regularly, usually every 6 months.

Compression stockings