Chronic Venous Leg Ulcers: Symptoms, Treatment & UK Online Doctor Support

A venous leg ulcer is a chronic, non-healing sore that typically develops on the inside of the leg, just above the ankle. In the UK, these ulcers are relatively common among older adults and represent a significant proportion of chronic wound care managed by the NHS. They occur when blood does not flow back to the heart efficiently, a condition known as venous insufficiency.

When the valves in the leg veins do not work correctly, blood pools in the lower limb. This increases pressure (venous hypertension), which eventually causes fluid to leak into the surrounding tissue. This fluid buildup leads to inflammation and damage to the skin, eventually resulting in a break or ulcer. Unlike a standard scrape or cut, a venous ulcer is slow to heal and requires specific medical management to resolve.

While the most obvious sign is an open sore, there are several preceding symptoms that UK patients should watch out for. These are often signs of chronic venous insufficiency and can include:

• Swollen ankles: Often worse at the end of the day or after long periods of standing.
• Discoloured skin: The skin around the ankle may turn brown or reddish (haemosiderin staining).
• Hardened skin: A condition called lipodermatosclerosis, where the skin feels tight or woody.
• Itching and eczema: Known as varicose eczema, making the skin red, flaky, and prone to irritation.
• Ache or heaviness: A persistent dull discomfort in the legs that improves when legs are elevated.

The ulcer itself is usually shallow with irregular borders. While they aren't always sharply painful, they can become very tender if they become infected or if the surrounding inflammation is severe.

Management of venous leg ulcers in the UK follows strict NICE (National Institute for Health and Care Excellence) guidelines. The primary goal is to reduce the pressure in the leg veins and encourage blood flow back to the heart.

Compression therapy

This is the gold standard of treatment. It involves applying firm pressure to the leg using specialised bandages or compression stockings. This helps the vein valves function better and reduces the swelling that prevents healing. Compression should only be applied after a healthcare professional has performed an ABPI (Ankle Brachial Pressure Index) test to ensure the blood supply to the arteries is healthy.

Wound dressings

Specialised dressings are used to protect the wound, absorb excess fluid, and provide the moist environment necessary for healing. Your GP or nurse will determine the best type of dressing based on the appearance and exudate level of the ulcer.

Lifestyle adjustments

Patients are encouraged to elevate their legs above the level of their heart whenever possible and to stay physically active. Walking helps the calf muscle pump blood out of the legs. Stopping smoking and managing weight are also vital components of long-term recovery.

If you have a sore on your leg that has not healed within two weeks, it is important to seek medical advice. You can speak to a GP online to discuss your symptoms and the appearance of your leg. While a physical assessment may be required for the initial ABPI test, a private GP consultation can be invaluable for:

• Initial Triage: Understanding if your symptoms align with venous disease or another condition.
• Management Advice: Discussing how to manage chronic symptoms like varicose eczema or swelling.
• Second Opinions: Reviewing current treatment plans and understanding the latest evidence-based options.
• Work and Travel Documentation: Providing sick notes if your condition limits your ability to perform your job or requires frequent rest.
• Prescriptions: In cases where the skin is heavily inflamed or infected, a doctor may prescribe topical treatments or antibiotics.

Once a venous ulcer has healed, the underlying venous insufficiency remains. Without preventative measures, there is a high risk of the ulcer returning. UK health guidelines recommend the long-term use of compression stockings even after the skin looks healthy. Regular skin moisturisation (emollients) can help prevent the skin from cracking, and keeping a healthy weight reduces the overall load on your circulatory system.