Leg ulcers

What are leg ulcers?

Leg ulcers are deep sores in the skin of the leg that often take a long time to heal. Unlike a graze, which only affects the first few layers of skin, an ulcer is deep and affects many layers of skin.

A leg ulcer can be acute or chronic. An acute ulcer usually starts to heal in less than 4 weeks. It might be from an injury. A chronic ulcer takes more than 4 weeks to heal and the cause is often complex.

Leg ulcers are the most common wounds in Australia. About 1 or 2 people in every 100 will develop a leg ulcer at some time in their lives. They are especially common among older people.

What are the symptoms of leg ulcers?

The main symptom of a leg ulcer is a deep sore on the leg.

You might also have:

• bleeding
• dry skin around the ulcer or a rash
• brown or blotchy skin around the ulcer
• itching
• pain and swelling that feels better when you raise your leg

Sometimes a leg ulcer can get infected. If this happens, symptoms include:

• swelling
• pain that gets worse
• pus — fluid weeping from the wound, that may have a bad smell
• a fever

What causes leg ulcers?

The most common type of leg ulcer is a venous leg ulcer. It is caused by high pressure in veins in the legs. High pressure may be due to diseases of the veins, a blood clot or when varicose veins have damaged the skin. When this happens, fluid leaks from the abnormal veins and this eventually leads to the skin breaking down.

Other causes of leg ulcers include:

• peripheral vascular disease (blocked arteries)
• some skin conditions such as vasculitis
• cancer
• injury to the leg
• infections

Older people are more at risk of developing a leg ulcer. You have a higher risk of getting a leg ulcer if you have diabetes or high blood pressure, if you are living with obesity, or if you are a smoker.

People with diabetes can have peripheral neuropathy (a type of nerve damage), which causes them to lose some sensations (feeling) in the legs or feet. This loss of sensation means they may not know that they have had an injury to their leg or foot, and could develop an ulcer without noticing. This is why people with diabetes need regular foot care.

How are leg ulcers treated?

Your doctor will examine you to see what type of leg ulcer you have — the type of treatment you need will be based on what has caused it.

Depending on the type of leg ulcer you have, you will need a special dressing and a bandage or a compression stocking over the ulcer. It is important to see a health professional who is skilled in managing leg ulcers. Wet ulcers (ulcers that are weeping or have pus) need a daily dressing change, but dry ulcers need moist dressings. If the ulcer is infected, you may need antibiotics. You will need different types of dressings, depending on the type of ulcer you have, if it is wet, dry or infected.

Sometimes, they will monitor healing by taking photographs and/or measuring the size and depth of the ulcer.

Raising your leg (for example, supported on a pillow while you sit) will help lower the pressure in your veins and help your ulcer heal. It’s best to raise your leg so it’s above the level of your heart whenever you are sitting.

Ulcers can take a long time to heal, sometimes weeks or months. This might be because you have poor circulation to your leg. When they do heal, they usually leave a scar. Chronic leg ulcers will come back.

It is important for your doctor to find and treat the underlying conditions that caused the ulcer to happen. Sometimes, this might involve medicines to improve blood supply to help the healing process, or surgery.

Can leg ulcers be prevented?

You are more likely to get a leg ulcer if you live with obesity, are unable to move around easily, or have ankle or leg swelling.

Leg ulcers tend to come back. If you are living with a leg ulcer, or want to prevent another one from forming, you can:

• quit smoking
• keep to a healthy weight
• get your hypertension (high blood pressure) or diabetes under control
• wear compression stockings, if your doctor recommends them
• keep your legs raised whenever you can
• exercise regularly

A podiatrist (expert in foot and leg health) can help you keep your feet healthy and prevent leg ulcers from recurring. They can also remove a callus or hard skin and help manage cracks before they become ulcers, and prevent infection.

When should I see my doctor?

It is important to see your doctor if you think you have a leg ulcer especially if you:

• have diabetes
• have high blood pressure
• live with obesity
• are an older person
• are a smoker

It is important to see your doctor so they can assess, diagnose and treat your leg ulcer as soon as possible. Many Australians need to go to hospital to treat diabetes-related foot ulcers, with might end up needing amputation. If you have diabetes, seek medical attention as soon as you notice symptoms to avoid these complications.