Venous ulcers - self-care
Venous leg ulcers - self-care; Venous insufficiency ulcers - self-care; Stasis leg ulcers - self-care; Varicose veins - venous ulcers - self-care; Stasis dermatitis - venous ulcer
Causes
The cause of venous ulcers is high pressure in the veins of the lower leg. The veins have one-way valves that keep blood flowing up toward your heart. When these valves become weak or the veins become scarred and blocked, blood can flow backward and pool in your legs. This is called venous insufficiency. This leads to high pressure in the lower leg veins. The increase in pressure and buildup of fluid prevents nutrients and oxygen from getting to tissues. The lack of nutrients causes cells to die, damaging the tissue, and a wound can form.
If you have dull, aching, or cramping pain in your legs, and pain that gets worse when you stand, you may have a condition called venous insufficiency. In venous insufficiency, the veins in your legs have trouble sending blood back to your heart. Normally, valves in your legs keep your blood flowing back towards your heart so it doesn't collect in one place. But the valves in varicose veins are either damaged or missing. This causes your veins to remain filled with blood, especially when you're standing. A blockage in your vein from a blood clot, called a deep venous thrombosis, can also cause this problem. So, how do you know if you have venous insufficiency? Well, you'll probably feel a dull aching, heaviness, or cramping in your legs. Your legs will swell up when you're on them too long. Your legs may itch or tingle. Pain will get worse when you stand, and better when you raise your legs. Your legs and ankles may also be red. You may notice skin color changes around your ankles. You may see varicose veins on the surface of your legs. You may feel thickening and hardening of the skin on your legs and ankles. So, what can you do about venous insufficiency? Well, your doctor will tell you to use compression stockings to decrease the swelling in your legs. You'll probably have to avoid long periods of sitting or standing. Even moving your legs slightly will help the blood in your veins return to your heart. Walking helps in that same way. Your doctor may recommend surgery or other treatments for varicose veins if you've tried everything and you still have leg pain that feels heavy or tired, skin ulcers or sores caused by poor blood flow. If blood clots are causing you problems, your doctor may prescribe anticoagulant or blood-thinning medicines, to treat existing blood clots and prevent others. Your doctor may suggest you try to keep your legs elevated above your heart when you lie down. You may improve your circulation through exercise. And finally, if you need to lose weight, weight loss can be a very helpful treatment of venous insufficiency and swelling.
Signs and Symptoms
When blood pools in the veins of the lower leg, fluid and blood cells leak out into the skin and other tissues. This can cause itchy, thin skin and lead to skin changes called stasis dermatitis. This is an early sign of venous insufficiency.
Other early signs include:
- Leg swelling, heaviness, and cramping
- Dark red, purple, brown, hardened skin (this is a sign that blood is pooling)
- Itching and tingling
Signs and symptoms of venous ulcers include:
- Shallow sore with a red base, sometimes covered by yellow tissue
- Unevenly shaped borders
- Surrounding skin may be shiny, tight, warm or hot, and discolored
- Leg pain
- If the sore becomes infected, it may have a bad odor and pus may drain from the wound
Who is At Risk?
Risk factors for venous ulcers include:
- Varicose veins
- History of blood clots in the legs (deep vein thrombosis)
- Blockage of the lymph vessels, which causes fluid to build up in the legs
- Older age, being female, or being tall
- Family history of venous insufficiency
- Obesity
- Pregnancy
- Smoking
- Sitting or standing for a long periods of time (usually for work)
- Fracture of a long bone in the leg or other serious injuries, such as burns or muscle damage
Wound Care
Your health care provider will show you how to care for your wound. The basic instructions are:
- Always keep the wound clean and bandaged to prevent infection.
- Your provider will tell you how often you need to change the dressing.
- Keep the dressing and the skin around it dry. Try not to get healthy tissue around the wound too wet. This can soften the healthy tissue, causing the wound to get bigger.
- Before applying a dressing, cleanse the wound thoroughly according to your provider's instructions.
- Protect the skin around the wound by keeping it clean and moisturized.
- You will wear a compression stocking or bandages over the dressing. Your provider will show you how to apply the bandages.
To help treat a venous ulcer, the high pressure in the leg veins needs to be relieved.
- Wear compression stockings or bandages every day as instructed. They help prevent blood from pooling, reduce swelling, help with healing, and reduce pain.
- Put your feet above your heart as often as possible. For example, you can lie down with your feet propped up on pillows.
- Take a walk or exercise every day. Being active helps improve blood flow.
- Take medicines as directed to help with healing.
If ulcers do not heal well, your provider may recommend certain procedures or surgery to improve blood flow through your veins.
Prevention
If you are at risk for venous ulcers, take the steps listed above under Wound Care. Also, check your feet and legs every day: the tops and bottoms, ankles, and heels. Look for cracks and changes in skin color.
Lifestyle changes can help prevent venous ulcers. The following measures may help improve blood flow and aid healing.
- Keep the skin of your lower legs well moisturized.
- Quit smoking. Smoking is bad for your blood vessels.
- If you have diabetes, keep your blood sugar level under control. This will help you heal faster.
- Exercise as much as you can. Staying active helps with blood flow.
- Eat healthy foods and get plenty of sleep at night.
- Lose weight if you are overweight.
- Manage your blood pressure and cholesterol levels.
When to Call the Doctor
Call your provider if there are any signs of infection, such as:
- Redness, increased warmth, or swelling around the wound
- More drainage than before or drainage that is yellowish or cloudy
- Bleeding
- Odor
- Fever or chills
- Increased pain
References
Boukovalas S, Aliano KA, Phillips LG, Norbury WB. Wound healing. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 6.
Hafner A, Sprecher E. Ulcers. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 105.
Smith SF, Duell DJ, Martin BC, Aebersold M, Gonzalez L. Wound care and dressings. In: Smith SF, Duell DJ, Martin BC, Aebersold M, Gonzalez L, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2017:chap 25.
Version Info
Last reviewed on: 5/10/2022
Reviewed by: Deepak Sudheendra, MD, MHCI, RPVI, FSIR, Founder and CEO, 360 Vascular Institute, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Columbus, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
