About 70% of people with ulcers have this type which are the result of venous disease. They tend to occur in the so-called Gaiter Area – halfway up the calf and down to just below the ankle. Veins drain blood from the feet & lower leg uphill to the heart. This blood has to be re-cycled through the heart and lungs to get rid of waste products and pick up oxygen. This system is important to keep the legs and feet healthy. Two mechanisms assist in this uphill flow of blood.
The Calf Muscle Pump: Muscles used for walking and exercise act as a pump by contracting and relaxing and helping to force blood uphill towards the heart.
Valves: The veins in the legs have one-way valves which prevent blood flowing back downhill.
If the valves do not work properly and do not close in the normal way blood will flow back downhill and cause congestion. This may lead to legs which are swollen and tender to touch. The skin may feel dry and itchy and have mottled brown or black staining, and may appear crusty in the gaiter area. The legs may become painful when sitting down. Venous ulcers can develop in this type of leg.
other ulcer types.
What Causes Chronic Venous Ulcers?
The following conditions indicate an increased risk for venous ulceration:
- A history of deep vein thrombosis, which can damage vein valves
- A family history of venous disease
- Lower-extremity edema, which increases the risk of tissue breakdown.
Certain conditions are also linked with the development of venous leg ulcers including:
- High Blood Pressure
- Varicose Veins
- Fractures or Injuries
- Multiple Pregnancies
- Previous Surgery
- Sitting or standing for long periods
What is the Treatment for Venous Ulcers?
Treatment goals include local wound care and correction of the underlying problem. Oral antibiotics are prescribed if there is infection and topical steroids are sometimes used for the surrounding skin irritation. The leg may be wrapped in a boot-like dressing that offers both medication soothing to the skin and compression. There are other dressings that may speed wound healing. The cornerstone of therapy for venous ulcers is the use of compression in the form of gradient compression therapy. There are new medications that contain growth factors which are not widely used but may hold hope for the future.
(a) Antiseptic solution
(b) Bio-occlusive dressings Pneumatic, gradient compression pump therapy