The causes and treatment of leg ulcers.

Leg ulcers are open wounds on your leg that take more than two weeks to heal despite treatment. These ulcers typically appear between the ankle and knee. Leg ulcers often seep (ooze fluid or pus) and can grow larger if left untreated. A sore on your leg that doesn’t heal after three months of treatment is considered a chronic condition.

How common are leg ulcers? Approximately 1% of American adults have leg ulcers. The problem is more common in older adults. About 4% of people over 65 have nonhealing sores on their legs.

Symptoms and Causes: What causes leg ulcers?

Chronic venous insufficiency: Chronic venous insufficiency occurs when faulty valves in leg veins allow blood to flow backward into the leg where it pools. If you develop high blood pressure in the leg veins, tiny blood vessels (capillaries) can burst, causing inflammation, itching and dry skin. Leg ulcers develop when the skin breaks open.

Diabetes: High blood sugar levels from diabetes can cause fat deposits to form inside blood vessels, causing them to narrow. Reduced blood flow can cause nerve damage or diabetic neuropathy. With these nerve problems, you may not be able to feel a leg ulcer or know it’s there. Diabetes also slows the wound healing process.

Peripheral artery disease (PAD): This condition causes plaque (fatty deposits) to build up in the arteries (atherosclerosis). The blood vessels in the leg become narrow, leading to poor blood circulation. The reduced blood flow slows the healing of leg ulcers. People with diabetes are more likely to develop PAD.

High blood pressure: Chronic, poorly controlled high blood pressure (hypertension) can cause an extremely painful ulcer on the lower leg called a Martorell ulcer. High blood pressure causes the capillaries in the skin to become narrow, cutting off the blood supply to the skin. The skin can die, forming a leg ulcer.

What are the risk factors for leg ulcers?

Women are twice as likely as men to develop leg ulcers. Other factors that make leg ulcers more likely include: Health conditions, such as diabetes, high blood pressure and rheumatoid arthritis.

Hip replacement or knee replacement procedures. Injuries and traumatic accidents, including broken bones.

Lack of physical activity, including paralysis.

Smoking. Varicose veins, vasculitis (inflamed blood vessels) and venous blood clots (thromboembolism).

What are the symptoms of leg ulcers? A lower leg wound that doesn’t heal with treatment after two weeks is the first indication of a leg ulcer. The sore may be red, purple, brown or yellow (or a mix of colors). Nonhealing sores on your legs often have a liquid discharge.

Other signs of a leg ulcer include: Dry, scaly or itchy skin. Hard bumps on the skin or hardened skin. Leg pain, especially after standing for a while. Red, blue or purplish skin color (like a bruise).Swelling (edema) in the lower legs.

Diagnosis and Tests. How are leg ulcers diagnosed?

A vascular specialist — a healthcare provider specializing in the circulatory system and knowledgeable about wound care — can examine the ulcer. Your provider will examine your skin and the wound.

Ankle-brachial index test, which uses ultrasound technology to measure blood pressure and blood flow in the legs. Biopsy to check skin cells and fluid from the wound for infections and skin diseases.

Management and Treatment: How are leg ulcers treated?

Leg ulcers can be challenging to eliminate. Even with treatment, wounds can persist for months or sometimes years. Treatments vary depending on the ulcer type and cause. Your healthcare provider will focus on healing the wound, reducing swelling and preventing the ulcer from coming back as it heals.

Leg ulcer treatments include: Compression therapy with stockings or bandages to stimulate blood flow to the legs. Leg elevation above the heart for one hour a day for at least six days. Wound care, including debridement (removal of dead skin tissue at a provider’s office), topical (skin) antiseptics to prevent infection and regular bandage changes.

Antibiotics to treat infections (when needed) and medications to open blood vessels and improve blood flow (vasodilators).

Hyperbaric oxygen therapy to get more oxygen into the blood and speed healing. Sclerotherapy or endovascular ablation to treat varicose veins. Surgery to remove, repair, replace or bypass a damaged vein. Skin grafts for wounds larger than 4 inches or ulcers that don’t heal with other treatments.

Outlook and Prognosis: What are the complications of leg ulcers? People with no healing wounds are at risk for: Bone infections such as osteomyelitis, which may lead to limb loss (amputation).