Venous Ulcer

Overview

What is a venous ulcer?

A venous ulcer, also known as venous stasis ulcer, is a wound that takes longer than usual to heal. It’s due to vein and blood flow issues and often occurs on your legs near your ankle.

How long do venous ulcers take to heal?

Venous ulcers can take several months to heal. In severe cases, the ulcer never heals.

How do venous ulcers form?

Venous ulcers occur when oxygen-poor blood can’t flow from your extremities back to your heart. Instead, it pools, creating pressure in your veins. This damages skin tissue and leads to an ulcer.

Symptoms and Causes

What causes venous ulcers?

Your veins contain tiny valves that keep blood circulating throughout your body. These valves snap open and shut to move blood against the force of gravity back to your heart. In some people, venous diseases affect valve functioning. Other medical conditions, like diabetes, can also put you at risk for leg and foot ulcers.

What types of venous disease cause venous stasis ulcers?

Chronic venous insufficiency is a common cause of valve dysfunction. It occurs when your valves are damaged or too weak to do their job.

Other venous ulcer causes include:

Who gets venous ulcers?

A variety of factors can raise your risk of venous ulcers. They include:

What do venous ulcers look and feel like?

They’re often shallow, irregularly shaped sores. The skin surrounding the stasis ulcer may be hard and discolored.

Symptoms of venous ulcers include

  • Dull ache.
  • Foul odor.
  • Itching.
  • Pus or other fluid that oozes from the sore.
  • Swelling (edema).

Diagnosis and Tests

How are venous stasis ulcers diagnosed?

A physical exam is typically all that’s necessary to diagnose a venous ulcer. Your healthcare provider may ask about your health history to learn about conditions that may have caused the ulcer.

Will I need any tests?

Testing lets your healthcare provider know how severe the ulcer is. You may also undergo regular testing to determine whether venous ulcer treatments are working.

Tests for venous ulcers include:

  • Ankle-brachial index, which takes blood pressure readings of your arms and legs.
  • Doppler study to listen to blood flowing through your veins.
  • Imaging studies, such as a CT scan to identify damaged or nonfunctioning valves.

Management and Treatment

Why is it important to seek venous ulcer treatment?

Venous ulcers don’t heal on their own. The longer you live with them, the greater the likelihood of permanent tissue damage. The damage can spread or cause infections that can become life- or limb-threatening, such as gangrene.

In severe cases, it may be necessary to surgically remove (amputate) your affected limb. Timely care from an experienced wound care provider significantly lowers this risk.

What venous ulcer treatments might I need?

The therapies that are best for you depend on the location and severity of the ulcer. Care typically includes frequent follow-up appointments to ensure treatments are working.

Venous ulcer treatments often include:

  • Antibiotics if there’s an infection.
  • Compression bandages or stockings to improve circulation.
  • Ointments that protect against germs.
  • Pain relievers and other therapies to quiet overactive nerves.
  • Procedures (debridement) to remove debris and dead tissue.
  • Referrals to specialists if you need help managing chronic conditions, such as diabetes.
  • Special bandages and dressings to keep the ulcer covered.
  • Wound cleaning daily to flush out bacteria and remove dead tissue.

Are other venous ulcer treatments available?

Venous ulcers that are severe or not responding to standard therapies may require additional treatments such as:

  • Growth factor therapy, injectable substances that attract healthy cells to ulcers.
  • Hyperbaric oxygen therapy, a treatment in which you sit in a special, pressurized chamber and inhale pure oxygen.
  • Lymphedema therapy, massage, skin care and bandaging techniques that clear fluid buildup.
  • Skin graft, replacing diseased skin with healthy skin from another part of your body.
  • Stem cell therapy, injections of bone marrow (the substance inside of your bones) to generate healthy tissue.
  • Venous disease treatment to correct blood pooling problems and improve circulation.

Prevention

How can I prevent venous ulcers?

Preventive care can help you avoid a venous stasis ulcer. If you’ve had one in the past, these steps can lower the risk of ulcers recurring (returning) after treatment.

Venous ulcer prevention includes:

Outlook / Prognosis

What is the outlook for people with venous ulcers?

With successful treatment, people with venous stasis ulcers can make a full recovery. But once you’ve had a venous ulcer, you’re more likely to experience them again in the future. They often come back in the same area.

Living With

What is daily life like with a venous ulcer?

While you’re undergoing treatment, there are steps you can take to promote healing. These include:

  • Eating a healthy diet, which supports your body’s natural healing abilities.
  • Keeping the ulcer and nearby skin clean.
  • Periodically raising your legs when seated to avoid blood pooling.
  • Staying active with gentle exercises, like walking.

A note from Cleveland Clinic

Venous stasis ulcers are wounds that are slow to heal. They typically occur in people with vein issues. Timely specialized care is necessary to prevent complications, like infections that can become life-threatening. Nonhealing ulcers also raise your risk of amputation. Venous ulcers can come back (recur) after treatment, which is why care often includes preventive therapies. Most people make a full recovery. But it’s essential to follow all care instructions.

Last reviewed by a Cleveland Clinic medical professional on 05/26/2022.

References

  • American College of Surgeons. Wound Home Skills Kit: Venous Leg Ulcers and Lymphedema. (https://www.facs.org/-/media/files/education/patient-ed/wound_venous_ulcers.ashx) Accessed 5/26/2022.
  • Collins L, Seraj S. Diagnosis and Treatment of Venous Ulcers. (https://www.aafp.org/afp/2010/0415/p989.html) Am Fam Physician. 2010;81(8):989-996. Accessed 5/26/2022.
  • Nelson EA, Adderley U. Venous Leg Ulcers. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714578/) BMJ Clin Evid. 2016;2016:1902. Published 2016 Jan 15. Accessed 5/26/2022.
  • Robles-Tenorio A, Lev-Tov H, Ocampo-Candiani J. Venous Leg Ulcer. (https://www.ncbi.nlm.nih.gov/books/NBK567802/) [Updated 2021 Apr 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 5/26/2022.
  • Vasudevan B. Venous Leg Ulcers: Pathophysiology and Classification. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144244/) Indian Dermatol Online J. 2014;5(3):366-370. Accessed 5/26/2022.

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