Some of the most frustrating wounds I treat are sores near the ankle that just will not close. Patients often tell me they have tried every cream and bandage. Venous ulcers are the most common type of leg ulcer. They almost always trace back to a problem in the veins. In other words, the wound is a symptom. To heal it, we have to treat the vein disease underneath. In this article, I explain how these wounds form and how to spot the early warning signs. I also cover what treatment looks like.
Key Takeaways
- Venous ulcers are open sores, usually near the inner ankle, caused by poor blood flow in the leg veins.
- They often follow years of swelling, skin darkening, and itchy or hardened skin.
- Compression, good wound care, and leg elevation are the foundation of healing.
- Treating the faulty veins, for example with ablation, can help ulcers heal and lower the chance they return.
- An ulcer that is red, hot, draining, or smells bad may be infected and needs prompt care.
How Healthy Leg Veins Work
Veins carry blood from your legs back to your heart. To do this against gravity, they rely on two things. First, your calf muscles squeeze the veins each time you walk. Second, tiny one-way valves inside the veins keep blood from slipping backward.
What Is Venous Insufficiency?
Chronic venous insufficiency happens when those valves weaken or the vein walls stretch. As a result, blood pools in the lower legs instead of moving up. The pressure inside the veins rises, especially when you stand. You can read more about this condition from MedlinePlus or in my article on venous insufficiency.
Common causes and risk factors include the following.
- Damaged valves from a past blood clot (DVT)
- Varicose veins
- A family history of vein disease
- Pregnancy, especially more than one
- Obesity
- Older age
- Long hours of standing or sitting, or limited movement
- Smoking
- A past leg injury or surgery
How Venous Ulcers Form
Over time, high pressure in the veins damages the small blood vessels and the skin above them. Fluid and blood cells leak into the tissue. So the skin becomes swollen, inflamed, and fragile. Eventually, even a small bump or scratch can open into a wound that does not heal. That is a venous ulcer.
These ulcers usually form on the inner side of the lower leg, just above the ankle. They tend to be shallow, with uneven edges, and may weep fluid. In contrast, ulcers from poor artery flow often form on the toes or heel. To compare the different types, see my article on the causes of leg ulcers.
Early Warning Signs to Watch For
In my experience, the skin gives plenty of warning before an ulcer opens. Watch for these changes in your lower legs.
- Leg swelling that gets worse by the end of the day
- Aching, heaviness, or cramping in the calves
- Brown, reddish, or purple skin near the ankle (see leg pigmentation)
- Itchy, flaky, or irritated skin
- Skin that feels tight, shiny, or hard
- Visible varicose veins
If you notice these changes, now is the time to get checked. Treating vein disease early can help prevent an ulcer from forming.
Why These Wounds Need Medical Care
These ulcers rarely heal well on their own. Instead, they tend to linger for months or come back after healing. Meanwhile, an open wound can become infected. In serious cases, infection can spread into deeper tissue. Call your doctor promptly if the ulcer becomes more painful, red, warm, or swollen. The same goes for pus or a bad smell. Fever is another warning sign.
How I Diagnose and Treat Venous Ulcers
First, I examine the wound and the whole leg. Then I perform a duplex ultrasound to see how blood flows through the veins and to find faulty valves. I also check artery flow, because compression is not safe when the arteries are badly narrowed. With these answers, we build a plan.
Compression Therapy
Compression is the foundation of healing. Bandages or compression stockings squeeze the leg, reduce swelling, and help push blood back toward the heart. After the ulcer heals, wearing compression helps prevent it from returning.
Wound Care
Keeping the ulcer clean and covered with the right dressing protects it and supports healing. Sometimes, dead tissue needs to be gently removed so healthy tissue can grow. If there is an infection, antibiotics may be needed.
Leg Elevation and Activity
Raising your legs above the level of your heart several times a day lowers vein pressure. In addition, regular walking strengthens the calf muscle pump. Keeping a healthy weight and quitting smoking also help.
Treating the Faulty Veins
Fixing the underlying vein problem can speed healing and lower the chance of the ulcer coming back. As an interventional radiologist, I use minimally invasive options that do not require large incisions. For example, radiofrequency ablation uses heat through a thin catheter to close a faulty vein. Then blood reroutes through healthy veins. For smaller veins near the wound, sclerotherapy may also help.
Preventing Ulcers From Coming Back
Once an ulcer heals, the goal is to keep it healed. Wear your compression as directed, stay active, raise your legs when you rest, and check your skin daily. Also, keep up with follow-up visits so we can catch changes early.
Coastal Vascular Center is a small, locally owned practice, not a corporate chain. You will see me at every visit, and I personally perform every procedure. There is no hand-off to a physician assistant or nurse practitioner. Learn more on our leg ulcers page.
Get Venous Ulcer Care With Dr. Ayar
Do you have a sore near your ankle that will not heal, or skin changes from vein disease? We can find the cause with ultrasound and build a plan to help it heal. You will see Dr. Ayar at every visit in Pearland or Lake Jackson.
