How are leg ulcers treated?
At Cleveland Clinic, patients are treated by a team of world-class experts in the Lower Extremity Wound Clinic in the Department of Vascular Medicine. This Clinic includes doctors, nurses and other medical specialists.
These experts work together to determine the cause of the ulcer and develop an individualized treatment program.
The goals of treatment are to relieve pain, speed recovery and heal the wound. Each patient's treatment plan is individualized, based on the patient's health, medical condition and ability to care for the wound.
Treatment options for all ulcers may include:
- Antibiotics, if an infection is present
- Anti-platelet or anti-clotting medications to prevent a blood clot
- Topical wound care therapies
- Compression garments
- Prosthetics or orthotics, available to restore or enhance normal lifestyle function
Venous Ulcer Treatment
Venous ulcers are treated with compression of the leg to minimize edema or swelling. Compression treatments include wearing compression stockings, multi-layer compression wraps, or wrapping an ACE bandage or dressing from the toes or foot to the area below the knee. The type of compression treatment prescribed is determined by the physician, based on the characteristics of the ulcer base and amount of drainage from the ulcer.
The type of dressing prescribed for ulcers is determined by the type of ulcer and the appearance at the base of the ulcer. Types of dressings include:
- Moist to moist dressings
- Alginate dressings
- Collagen wound dressings
- Debriding agents
- Antimicrobial dressings
- Composite dressings
- Synthetic skin substitutes
Arterial Ulcer Treatment
Arterial ulcer treatments vary, depending on the severity of the arterial disease. Non-invasive vascular tests provide the physician with the diagnostic tools to assess the potential for wound healing. Depending on the patient's condition, the physician may recommend invasive testing, endovascular therapy or bypass surgery to restore circulation to the affected leg.
The goals for arterial ulcer treatment include:
- Providing adequate protection of the surface of the skin
- Preventing new ulcers
- Removing contact irritation to the existing ulcer
- Monitoring signs and symptoms of infection that may involve the soft tissues or bone
Treatment for neurotrophic ulcers includes avoiding pressure and weight-bearing on the affected leg. Regular debridement (the removal of infected tissue) is usually necessary before a neurotrophic ulcer can heal. Frequently, special shoes or orthotic devices must be worn.
Foot Care Guidelines
The treatment of all ulcers begins with careful skin and foot care. Inspecting your skin and feet is very important, especially for people with diabetes. Detecting and treating foot and skin sores early can help you prevent infection and prevent the sore from getting worse.
Gently wash the affected area on your leg and your feet every day with mild soap (Ivory Snow or Dreft) and lukewarm water. Washing helps loosen and remove dead skin and other debris or drainage from the ulcer. Gently and thoroughly dry your skin and feet, including between the toes. Do not rub your skin or area between the toes.
Every day, examine your legs as well as the tops and bottoms of your feet and the areas between your toes. Look for any blisters, cuts, cracks, scratches or other sores. Also check for redness, increased warmth, ingrown toenails, corns and calluses. Use a mirror to view the leg or foot if necessary, or have a family member look at the area for you.
Once or twice a day, apply a lanolin-based cream to your legs and the soles and top of your feet to prevent dry skin and cracking. Do not apply lotion between your toes or on areas where there is an open sore or cut. If the skin is extremely dry, use the moisturizing cream more often.
Care for your toenails regularly. Cut your toenails after bathing, when they are soft. Cut toenails straight across and smooth with a nail file.
If you have diabetes, it is important to see a podiatrist regularly.
Do not self-treat corns, calluses or other foot problems. Go to a podiatrist to treat these conditions.
Don't wait to treat a minor foot or skin problem. Follow your doctor's guidelines.
Wound Care at Home
Patients are given instructions to care for their wounds at home. These instructions include:
- Keeping the wound clean and dry
- Changing the dressing as directed
- Taking prescribed medications as directed
- Drinking plenty of fluid
- Following a healthy diet, as recommended, including plenty of fruits and vegetables
- Exercising regularly, as directed by a physician
- Wearing appropriate shoes
- Wearing compression wraps, if appropriate, as directed