What are leg ulcers?

Leg ulcers are deep, slow-healing sores on the legs or feet that form when the skin breaks down and doesn't heal properly. They are common, especially in older people.

Unlike a shallow wound or graze, an ulcer affects deeper layers of the skin. They often leave a scar after they heal.

What causes leg ulcers?

Leg ulcers can be caused by problems with blood flow, nerve function or other health conditions. Some medicines may also cause leg ulcers.

It's also common for leg ulcers to have more than one cause.

Venous leg ulcer causes

The most common type of leg ulcer is a venous leg ulcer.

Your leg veins contain valves that help maintain blood flow only in the direction of your heart (up). If the valves are damaged or weakened, blood can pool in your leg veins, leading to high pressure in those veins. This can be due to:

• varicose veins
• blood clots (thrombosis)
• a leg injury or fracture
• heart failure

Over time, poor vein function leads to symptoms and skin damage, which can lead to ulcers.

Arterial leg ulcer causes

Arterial ulcers happen when the arteries in the legs become narrowed or blocked. This means that your skin doesn't get enough blood and oxygen. This may be due to:

• peripheral vascular disease (blocked arteries)
• atherosclerosis (build-up of fatty substances in the arteries)
• smoking
• heart conditions, such as high blood pressure, heart attack or atrial fibrillation
• diabetes
• kidney disease
• stroke

Neuropathic ulcers

Neuropathic ulcers can form if you have a condition that affects the nerves in your legs and feet (peripheral neuropathy).

Nerve damage can reduce sensation and feelings of pain, especially in your lower legs and feet. Since you may not feel pressure or pain in these areas, the skin can become damaged without you realising, leading to ulcers that are slow to heal.

Neuropathic ulcers are common in diseases such as diabetes. They can also occur if you have other problems that affect your nerves, such as a spinal cord injury.

Other causes

Leg ulcers can also form if you have other conditions, including:

• pressure sores
• skin conditions such as pyoderma gangrenosum — associated with inflammatory bowel disease
• some cancers, especially skin cancers
• traumatic injury, especially if the wound has an infection that is hard to treat
• peripheral oedema (lower limb swelling) — this can be caused by a range of conditions, including heart disease

What are the symptoms of leg ulcers?

The main symptom of a leg ulcer is a deep sore on the leg that takes time and care to heal properly. You may or may not experience pain, depending on the cause. Other symptoms may also depend on the cause.

Venous leg ulcer symptoms

Here are some signs that your wound may be due to a venous leg ulcer:

• The ulcer is usually on the lower part of your leg.
• Your wound may have heavy fluid or discharge.
• You have swelling in your lower legs (oedema).
• You have dark purple or rust-coloured skin staining around the lower legs.
• You have thickened or hardened skin on your legs.
• Your pain eases when you lift your legs and gets worse when you lower them.

Arterial leg ulcer symptoms

Here are some signs that your wound may be due to an arterial leg ulcer:

• The ulcer is usually on your toes, bony areas, side of your feet or heel and may have little or no fluid or discharge
• Your legs or feet are cold and pale.
• Your legs become pale when you raise them, and they turn red when you lower them.
• You have hair loss on your legs or changes to your nails.
• You have weak or absent pulses in your feet.
• Your pain is worse when you are lying down and improves when your feet are lower than your hips.

Other symptoms

Symptoms of other types of ulcers may depend on the cause.

If you have a neuropathic ulcer, you may have little or no pain around the ulcer. For this reason, it's important for people with conditions (such as diabetes) that can reduce sensation in their feet and legs to check their feet and legs regularly for signs of injury.

When should I see my doctor?

See your doctor if you have:

• pain
• swelling
• signs of infection
• a wound or sore that isn't healing
• vein or artery problems and you develop a sore on your leg

Leg ulcers often need treatment to help them heal and to stop them from getting worse. Early treatment can help prevent complications.

Seek medical care if you have signs of complications, such as:

• aching, cramping or itching in your leg
• heaviness in your leg
• changes to the skin colour in your leg

When to seek urgent care

Seek urgent care if you use compression bandages or stockings on your legs and experience:

• numbness
• difficulty moving your leg
• a lot of pain
• difficulty breathing

Some people with leg ulcers may need treatment in hospital.

How are leg ulcers diagnosed?

Your doctor will ask about your health and examine your leg to help find the cause of your symptoms. Different tests can help confirm the diagnosis and guide treatment.

Common tests your doctor may consider include:

• blood tests
• blood glucose tests
• wound swab — to check for bacteria
• ultrasound (duplex ultrasound) — to check the blood flow in your veins and arteries
• biopsy — a small sample of the skin may be taken
• ankle-brachial index test — compares the blood pressure in your ankle and arm

How are leg ulcers treated?

The treatment for leg ulcers depends on the cause of the ulcer.

Because leg ulcers can be difficult to heal, it's common to be referred to a specialist doctor or wound care nurse for advice and support.

Treating venous leg ulcers

The main treatment for venous leg ulcers is compression therapy. This means using compression bandages or stockings on the lower leg. Compression can reduce swelling (oedema) and improve blood flow.

Other treatments include:

• elevating your leg above heart level to help blood flow
• keeping the wound clean and using antibiotics if needed
• using suitable dressings, depending on whether the ulcer is wet, dry or infected — your doctor or wound care nurse can advise you

After the ulcer has healed, your doctor may advise you to wear compression stockings long term to help prevent new ulcers.

Treating arterial leg ulcers

If you have an arterial ulcer, you may need surgery to restore blood flow to your lower leg. Compression bandages are usually avoided unless your specialist advises it, as these can further reduce blood flow to your leg and foot. Dressings may help the ulcer heal by keeping the wound moist and protected.

It's also important to manage risk factors, such as:

• high blood pressure
• smoking
• diabetes

Other treatments

Depending on your situation, your doctor may recommend:

• antibiotics — topical (applied to the wound itself) or oral
• medicines to promote healing
• a skin graft

Living with leg ulcers

Living with a leg ulcer can be challenging, but there are things you can do to encourage healing and reduce the chance of recurrence.

• Keep the wound clean and dressed as advised by your doctor or wound care nurse.
• Check your ulcer regularly for signs of healing. Your healthcare team may measure the size and depth of the ulcer to track progress.
• Manage pain with your doctor's advice.
• Stay as mobile as you can. Moving your ankle and walking helps blood flow, which supports healing.
• Learn how to care for your skin and reduce the chance of new ulcers forming. Your healthcare team can help with this.

What are the complications of leg ulcers?

If leg ulcers are not treated properly, they can lead to problems such as:

• wound infection, which can spread if not treated
• scarring
• difficulty walking, due to pain or swelling
• ulcers that come back after healing
• slow healing
• In some cases, the ulcer may not heal at all, and amputation might be necessary.

Can leg ulcers be prevented?

You can't always prevent leg ulcers, but there are things you can do to lower the chance of them developing.

Here are some tips that may help:

• Look after your skin — keep your skin clean and moisturised. Ask your doctor or wound care nurse for advice if you aren't sure how to do this.
• Protect your legs from injury and check your legs and feet daily for cuts, swelling or skin changes, especially if you have reduced sensation in your feet and legs.
• Quit smoking.
• Keep to a healthy weight.
• Treat health problems early — get your hypertension (high blood pressure), cholesterol or diabetes under control.
• Wear compression stockings, if your doctor recommends them.
• Stay active — walking and gentle leg exercises help improve blood flow.

Resources and support

For more information about leg ulcers, you can visit these websites:

• Australasian College of Dermatologists has information on leg ulcers.
• Diabetes Australia has information on how to care for your feet.
• Australia and New Zealand Society for Vascular Surgery has information on chronic venous insufficiency and leg ulcers.
• The Department of Health, Disability and Ageing has information on how to quit smoking.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

Languages other than English

• Call the Quitline Interpreter Service — if you prefer a language other than English call 13 7848 and ask for an interpreter. They will call you back with an interpreter in your language.

Information for Aboriginal and/or Torres Strait Islander peoples

• Get tips on quitting smoking by calling Quitline for Aboriginal and Torres Strait Islander Communities — call 13 7848.