Leg ulceration is simply a defect in the skin surface below the level of the knee joint. A small ulcer could be related to some injury or bug bite and will typically heal in short order with simple hygienic care. Chronic leg ulceration is defined as ulceration that lasts more than six weeks and is difficult to heal and often returns in short order. The condition affects 1% of the population and nearly 4% of individuals over 65 years of age and over 5% of persons over 80.
Chronic leg ulcers can be caused by a variety of issues and when most people think of ulcers, diabetes and atherosclerotic disease tend to be the first considerations. However, the truth is that 70% of all ulcerations are caused by venous disease. And, while diabetic and arterial ulcers related to atherosclerosis typically occur on the bottom of the foot or toes, nearly 90% or more of ulcers in the lower calf region are related to venous issues. Over $15 billion health care dollars are spent on the treatment of venous ulcerations in the United States every year.
Venous ulcerations are most often found on the inside aspect of the calf, typically just above the ankle bone. The ulcer is often somewhat irregular in shape but the edges of the ulcer are easy to see, and there is often fluid weeping from the wound. When veins are not able to properly move blood and fluid back up the leg to the heart, there is a buildup of fluid and protein which causes inflammation and skin breakdown. While a new ulcer may heal in a few weeks, without a fix to the underlying vein problem, fluid will continue to accumulate and the ulcer will often quickly recur and typically take progressively longer to heal.
The two most common causes of these venous or “stasis” ulcers, as they are often called, are varicose veins and/or a history of venous thrombosis (DVT) with blood clots in the veins that cause inflammation and destroy special venous valves, resulting in a situation similar to varicose veins where fluid is unable to return to the heart via the leg veins in normal fashion. Ulcers may form with no visible varicose veins if damage from clots is occurring in deep veins that are below the skin surface and can only be identified with specialized ultrasound imaging. In contrary fashion, some individuals may have large varicose veins for years and have no problems with ulceration because they are quite active and utilizing the muscles of the leg to actively pump blood back up the leg and avoid a stasis condition. Interestingly, it isn’t too unusual that these individuals may have no problem for many years but suddenly develop skin breakdown in the face of some lower body injury or joint surgery that limits ambulation and perhaps results in weight gain that puts pressure on the abdomen and limits fluid flow from the legs.
Oftentimes ulceration is preceded by darkening or redness of the skin in the front or side of the calf, often associated with itching that may get progressively worse over a few months. If you have varicose veins or have history of venous blood clots, this is the time to have your legs checked. Often symptoms can be relieved with treatment of the leaking veins with laser or simply with utilization of compression stockings. A simple walking program and or some weight loss, even to a mild degree may even make a world of difference. Once ulceration has occurred, treatment of the underlying venous issue along with good wound care will usually produce healing. However, the longer the ulcer stays untreated the more difficult wound care and healing becomes, and risk of infection rises.
The simplest solution is active, effective and early treatment. Skin color change and itching are the warning signs. Take heed. Simple ultrasound imaging and minimally invasive laser treatment (all done in The Vein Clinic) may be all that is needed to prevent many years of grief. Call us today to return to Healthy Legs!
