Chronic Venous Leg Ulcers: Symptoms, Causes, and Management in the UK

A venous leg ulcer is a chronic, long-lasting sore that takes more than two weeks to heal. It typically develops on the inside of the leg, just above the ankle. In the UK, these are the most common type of leg ulcer, accounting for approximately 80% of cases. According to NHS data, they affect around 1 in 500 people, though the prevalence increases significantly with age.

These ulcers occur when there is sustained high pressure in the veins of the lower leg. This condition, known as chronic venous insufficiency, causes fluid to leak out of the veins and into the surrounding tissue. This leads to inflammation, swelling (oedema), and eventually, the breakdown of the skin into an open wound.

Recognising the early signs of a venous ulcer is vital for effective treatment. Unlike arterial ulcers, which are often very painful and located on the toes or feet, venous ulcers have distinct characteristics:

• Location: Usually found on the lower leg, specifically the 'gaiter' area just above the ankle bone.
• Appearance: They are often shallow with irregular borders. The base of the ulcer typically appears red and may produce a discharge (exudate).
• Associated Skin Changes: The surrounding skin often looks discoloured (brown or rusty due to haemosiderin staining), firm, or inflamed (varicose eczema).
• Pain: While they can be uncomfortable, the pain is often described as a dull ache or heaviness that improves when the leg is elevated.

The primary cause is venous hypertension. This happens when the valves in the leg veins—which are supposed to prevent blood from flowing backwards—become weakened or damaged. When these valves fail, blood pools in the lower legs.

Who is at risk?

• Age and Mobility: Risk increases as we get older or if mobility is restricted, as the 'calf pump' mechanism that helps return blood to the heart becomes less efficient.
• Previous Deep Vein Thrombosis (DVT): A history of blood clots can permanently damage vein valves.
• Varicose Veins: Swollen, enlarged veins are a clear sign of underlying venous pressure issues.
• Obesity: Excess weight increases the pressure on the venous system in the legs.
• Profession: Jobs that require long periods of standing or sitting without movement.

Management of venous leg ulcers in the UK follows strict NICE (National Institute for Health and Care Excellence) guidelines. The goal is to reduce venous pressure and provide an environment conducive to wound healing.

Compression Therapy

Compression is the 'gold standard' treatment. This involves applying firm bandages or specialised stockings to the leg to assist blood flow. Note: A Doppler ultrasound test must be performed by a clinician before compression is applied to ensure there is no significant arterial disease (PAD), as compression can be dangerous in those cases.

Wound Dressings

A variety of dressings are used depending on the amount of discharge and the presence of infection. These are usually changed weekly alongside compression bandage replacement.

Lifestyle Adjustments

Patients are encouraged to elevate their legs above the level of their heart whenever possible and to stay as active as they safely can to improve circulation.

If you have a sore on your leg that has not healed within two weeks, you should seek medical advice. While an online doctor cannot perform a physical Doppler test, they are invaluable for the initial assessment and long-term management of chronic conditions.

Speaking to a GP online in the UK allows you to:

• Discuss your symptoms and upload photos for a preliminary visual assessment.
• Review your medical history to identify risk factors like previous DVT or heart failure.
• Receive advice on managing varicose eczema or skin irritation.
• Obtain referrals to local NHS tissue viability clinics or vascular specialists for definitive diagnosis.
• Get prescriptions for associated treatments, such as emollients for dry skin or antibiotics if the ulcer becomes infected.

Once a venous ulcer has healed, the risk of it returning is high without preventative measures. UK healthcare guidance stresses the importance of lifelong maintenance:

• Compression Stockings: Wearing medical-grade hosiery daily is the most effective way to prevent new ulcers.
• Skin Care: Keeping the skin hydrated with soap substitutes and emollients prevents the breakdown that leads to ulceration.
• Weight Management: Reducing strain on the veins through healthy eating and weight loss.
• Elevation: Continuing to rest with legs raised for at least 30 minutes, three times a day.