Leg Ulcers
Slow-healing open sores on the lower leg
Quick Facts
- Type: Skin / circulatory symptom
- Common causes: Vein disease, artery disease, diabetes
- Key feature: Sores that are slow to heal
- See a doctor: Any non-healing leg wound or signs of infection
Overview
A leg ulcer is an open sore or wound on the lower leg or foot that fails to heal within the usual time, often persisting for weeks or months. Unlike an ordinary cut or scrape that closes over in days, a leg ulcer reflects an underlying problem, most commonly poor circulation, that prevents normal healing.
Leg ulcers are common, especially in older adults and people with diabetes, vein disease, or artery disease. They can be painful, prone to infection, and slow to recover, but with the right treatment of both the wound and its underlying cause, most heal. Identifying the type of ulcer is important because the treatment differs depending on whether the problem is in the veins, the arteries, or the nerves and skin.
Common Causes
Most leg ulcers result from conditions that impair blood flow or skin integrity in the lower limbs. The main types and causes include:
- Venous ulcers: The most common type, caused by poor return of blood in the leg veins (venous insufficiency), often near the inner ankle.
- Arterial ulcers: Caused by reduced blood supply from narrowed arteries (peripheral artery disease), often painful and on the toes, foot, or outer ankle.
- Diabetic (neuropathic) ulcers: Related to nerve damage and reduced sensation, typically on the sole or pressure points of the foot.
- Pressure ulcers: From prolonged pressure in people with limited mobility.
- Other causes: Infection, inflammatory conditions, certain medications, and, rarely, skin cancer.
Smoking, obesity, immobility, varicose veins, and previous leg clots all increase the risk of developing a leg ulcer.
Associated Symptoms
The features around a leg ulcer help identify its cause. Associated symptoms may include:
- Swelling, aching, or heaviness in the leg (typical of vein problems)
- Brown or discolored, hardened, or itchy skin around the ankle
- Cold, pale, or hairless skin and pain at rest (suggesting artery disease)
- Numbness or reduced sensation in the foot (suggesting nerve damage)
- Discharge, odor, increasing redness, warmth, or fever (signs of infection)
Spreading redness, pus, foul odor, fever, or a rapidly worsening wound point to infection and need prompt medical attention.
Diagnosis & Evaluation
A clinician examines the ulcer and the leg to determine its type and cause. Evaluation may include:
- Examination of the wound, its location, edges, and surrounding skin.
- Checking pulses and circulation, including an ankle-brachial index to compare blood pressure in the ankle and arm.
- Ultrasound to assess blood flow in the veins or arteries.
- Blood tests, including blood sugar to check for diabetes.
- A wound swab if infection is suspected, and rarely a biopsy for non-healing or unusual ulcers.
Treatment & Management
Treatment addresses both the wound and the underlying cause. Approaches depend on the ulcer type:
- For venous ulcers: Compression therapy (bandages or stockings) to improve blood return, leg elevation, and wound dressings.
- For arterial ulcers: Improving blood flow, sometimes with procedures to open narrowed arteries; compression is generally avoided here.
- For diabetic foot ulcers: Controlling blood sugar, relieving pressure (offloading), and careful foot care.
- Wound care with appropriate dressings, keeping the wound clean, and removing dead tissue.
- Antibiotics if the ulcer is infected.
- Treating contributing factors, such as quitting smoking and managing swelling.
Healing can be slow, and ulcers may recur, so ongoing skin and circulation care is important even after a wound closes.
Self-Care & Prevention
- Manage conditions such as diabetes, high blood pressure, and vein disease
- Wear compression stockings if advised for vein problems
- Keep skin clean and moisturized, and inspect feet and legs daily, especially with diabetes
- Stay active, elevate the legs when resting, and maintain a healthy weight
- Stop smoking to improve circulation and healing
When to See a Doctor
See a doctor for any leg sore that does not begin to heal within a couple of weeks, especially if you have diabetes or circulation problems. Seek prompt care for:
- Spreading redness, warmth, swelling, pus, or foul odor
- Fever or feeling generally unwell
- Increasing pain or a rapidly enlarging wound
- A black or dead-looking area of skin
- A painful, cold, pale foot, which can signal severely reduced blood flow and is an emergency
Frequently Asked Questions
What causes leg ulcers?
Most leg ulcers come from poor circulation. Venous ulcers, the most common, result from sluggish blood return in the leg veins; arterial ulcers come from narrowed arteries; and diabetic foot ulcers stem from nerve damage and reduced sensation. The cause guides treatment.
Why won't my leg ulcer heal?
Leg ulcers heal slowly because the underlying problem, usually poor blood flow or diabetes, interferes with normal repair. Untreated swelling, infection, or continued pressure also delay healing. Treating the root cause, not just the wound, is key to recovery.
How are venous leg ulcers treated?
Venous ulcers are treated mainly with compression therapy using bandages or stockings to improve blood return, along with leg elevation and proper wound dressings. Treating vein disease and managing swelling reduce the chance the ulcer comes back.
When is a leg ulcer an emergency?
Seek urgent care for spreading redness, pus, foul odor, fever, a rapidly enlarging or blackened wound, or a painful, cold, pale foot. These can signal serious infection or critically reduced blood flow that needs immediate treatment.
References
- National Heart, Lung, and Blood Institute (NHLBI). Peripheral Artery Disease.
- Mayo Clinic. Venous ulcers and chronic venous insufficiency.
- MedlinePlus, U.S. National Library of Medicine. Leg and foot ulcers.
- NHS. Venous leg ulcer.