An ulcer is an open sore that does not heal or is recurrent. Ulcers can develop on your lower legs, most often around the ankles, or wherever there is consistent pressure on the foot. If they are small, they can be quickly treated, and we can keep them from returning. But if an ulcer is left to grow deeper into the skin tissue, or if it becomes infected, treatment will likely be drastic–and expensive.
How does a lower leg ulcer develop? Are there different kinds of ulcers? Read on to get a better understanding of ulcers, their treatment options and the best methods of prevention.
The most common ulcers of the lower leg are venous ulcers. These occur when veins in the leg do not return blood back to the heart, a condition called chronic venous insufficiency. The unreturned blood pools in the leg tissue, causing swelling and low oxygen levels. As a result, a simple wound is unable to heal and becomes larger, leading to venous stasis ulceration.
Venous ulcers range from being painless to quite painful over time. They usually develop just above the ankle and on the inner leg. A telling sign of a venous ulcer is a brown, rust-colored pigmentation. Once it develops, the ulcer is red in color and possibly tinted with yellow fibrous tissue. A green or yellow discharge is also possible if it is infected. The surrounding skin might be warm and appear shiny and tight.
Venous ulcers usually affect older patients with a history of vein disease, varicose veins, and blood clotting. The fundamental cause is poor circulation, which can be brought on a number of ways, from atherosclerosis, obesity, heart disease, or smoking. Genetics, certain medications, and simply standing or sitting for too long on a daily basis can also factor in.
Diabetic and Arterial Ulcers
Though much less common, diabetic (neurotrophic) and arterial (ischemic) ulcers can be equally dangerous if left untreated. Their cause, appearance, location, and treatment are different from venous ulcers, so it is important to have an expert diagnose them. If left untreated and infected, they can lead to amputation.
Diabetic or neurotrophic ulcers are a result of an impaired sensation in the feet and decrease in wound healing, usually from diabetic nerve damage. They occur at pressure points on the bottom of the feet or wherever a wound has formed. Because of the lack of sensation, the patient is often unaware of them. It is important that diabetic patients inspect their feet daily. They can be pink/red or brown/black with a punched out or calloused/cracked border.
Arterial or ischemic ulcers on the other hand are extremely painful and caused by arterial disease, like atherosclerosis and peripheral arterial disease (PAD). They are unable to heal because of lack of blood in the tissue due to poor circulation. They often develop on the feet, especially the toes, and occasionally on the ankles. Their appearance is yellow, brown, gray, or black. They usually do not bleed. Like diabetic ulcers, the surrounding skin appears punched out. The pain is greatest at night and can be relieved by dangling the legs off the bed.
Treatments and Prevention
Venous ulcers can be treated in a variety of ways, most commonly with compression treatments. Lifting the legs above the heart whenever possible also helps. It is important to treat the underlying cause of the ulcer, too, to prevent recurrence. For venous ulcers, this includes closure of the abnormal veins causing venous insufficiency with ablation therapy.
For arterial ulcers, a proper diagnosis must be made to determine the potential for wound healing. Compression therapy does not work for arterial ulcers and can make them worse. Treatments involve attempting to re-vascularize the leg through endovascular therapy. Treatment for neuropathic ulcers include debridement or removal of infected tissue, avoiding pressure on the ulcerated leg, and special shoes to prevent contact irritation.
Ulcers of the lower leg can be prevented by checking your ankles and legs daily for early signs of ulceration. This is key to getting the preventative treatment you need. Taking daily walks, eating healthier, quitting smoking, and anything that improves overall circulation will go a long way in preventing ulcers and venous/heart conditions.
How to Treat Your Ulcer at the Source
Whether you need an accurate diagnosis for your lower leg ulcer, or need treatment, Texas Endovascular has the vein expertise necessary to help. Schedule an appointment with us today and we’ll get you on the path to recovery.
Sources: Circulation Foundation