Lower Extremity Ulcers

What are Ulcers?
Ulcers are wounds or open sores that will not heal or keep returning.

What causes leg ulcers?
Lower Extremity Ulcers may be caused by medical conditions such as:

  • Poor circulation, often caused by arteriosclerosis
  • Venous insufficiency (a failure of the valves in the veins of the leg that causes congestion and slowing of blood circulation in the veins)
  • Other disorders of clotting and circulation that may or may not be related to atherosclerosis
  • Diabetes
  • Renal (kidney) failure
  • Hypertension (treated or untreated)
  • Lymphedema (a buildup of fluid that causes swelling in the legs or feet)
  • Inflammatory diseases including vasculitis, lupus, scleroderma or other rheumatological conditions
  • Other medical conditions such as high cholesterol, heart disease, high blood pressure, sickle cell anemia, bowel disorders
  • History of smoking (either current or past)
  • Pressure caused by lying in one position for too long
  • Genetics (ulcers may be hereditary)
  • A malignancy (tumor or cancerous mass)
  • Infections
  • Certain medications

What are the types of leg and foot ulcers?
The three most common types of leg and foot ulcers include:

  • Venous stasis ulcers
  • Neurotrophic (diabetic)
  • Arterial (ischemic ulcers)

Ulcers are typically defined by the appearance of the ulcer, the ulcer location, and the way the borders and surrounding skin of the ulcer look.

What are the symptoms of ulcers?
Ulcers may or may not be painful. The patient generally has a swollen leg and may feel burning or itching. There may also be a rash, redness, brown discoloration or dry, scaly skin.

How are leg ulcers diagnosed?
First, the patient’s medical history is evaluated. A wound specialist will examine the wound thoroughly and may perform tests such as X-rays, MRIs, CT scans and noninvasive vascular studies to help develop a treatment plan.

How are leg ulcers treated?
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
  • Hydrogels/hydrocolloids
  • 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.

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