Approximately 80% of leg ulcers are venous ulcers. Venous are usually located above the ankle and below the knee. The appearance is dark red with granular composition and dead tissue is common. Venous Ulcers can be big or small, wet or dry, painful or not painful, odorous or not odorous. Leg veins includes many valves that prevent blood from flowing backwards towards the foot as it is being pumped upward towards the heart. This is called “Venous Reflux” When a person is standing the pressure of the blood in the legs (Venous Pressure) equals the weight of the blood column between the foot and the right atrium. This pressure should be in the 80-100 mmHG range. When a person is walking the foot and calf muscles increase the flow of blood upwards. When the valves in the veins are damaged the blood is oscillating/slushing around instead of being pumped upwards. Picture some of the blood falling downward towards the foot, when all should be going upward towards the heart. The added pressure from the blood falling backwards eventually elongates the veins. The blood is not oxygenated as it should be. The skin will eventually break down allowing bacteria to infect areas below the skin. When an ulcer appears many will apply creams and ointments hoping to heal the area but the real cause comes from underneath, lacking blood supply.
Other Factors that can contribute or cause “Leg Ulcers”
- Kidney Failure
- Poor circulation, often caused by arteriosclerosis
- Specific Medications
- Pressure caused lying in one position – Wheelchair or bedridden
- Prone because of Genetics
- Sickle Cell Anemia
- High Cholesterol
- Heart Disease
- High Blood Pressure
- Lymphedema (a buildup of fluid that causes swelling in the legs or feet)
- Inflammatory diseases including vasculitis, lupus, scleroderma or other rheumatological conditions
Treatment: Healing rates of up to 70% at 12 weeks can be obtained and when combined with a program to prevent ulcer recurrence can dramatically improve patient outcome. Effective symptom control either with dressings or analgesia can improve quality of life and patient tolerance of compression therapy. The higher the level of compression the patient can tolerate the lower the recurrence rate. Compression Stockings are the mainstay of venous ulcer management. Gradual compression, with greatest pressure (about 40 mm Hg) at the ankle, tapering off to lower pressure (about 18 mm Hg) below the knee. Various compression bandage systems and stockings can be used. If numbness, pain, tingling occur seek medical advice.