Chronic Venous Leg Ulcers: Symptoms, Treatment & UK Management Guide

A venous leg ulcer is a long-lasting (chronic) sore that develops on the leg, usually just above the ankle. In the United Kingdom, these ulcers affect approximately 1 in 500 people, though the prevalence increases significantly with age. They occur when high pressure in the veins of the lower leg causes fluid to seep out, damaging the skin and eventually leading to a breakdown in the tissue.

Unlike acute wounds that heal quickly, chronic venous ulcers persist for more than six weeks. According to NHS guidance, these are primarily caused by underlying venous insufficiency, where the valves in the leg veins do not work effectively to pump blood back up to the heart. This leads to blood 'pooling' in the lower limbs, a condition known as venous hypertension.

Identifying a venous leg ulcer early can significantly improve the healing timeline. The ulcer itself usually appears as a shallow, red sore, sometimes covered by a thin layer of yellow-grey tissue. The edges are often irregularly shaped.

Accompanying symptoms typically include:

• Oedema: Swelling in the ankles and lower legs, which may worsen throughout the day.
• Discolouration: The skin around the ulcer may become dark brown or rusty in colour (haemosiderin staining).
• Venous Eczema: The skin may become itchy, red, flaky, or hardened (lipodermatosclerosis).
• Aching: A persistent heavy or aching feeling in the legs, often relieved by elevation.
• Discharge: The wound may produce a clear or yellowish fluid.

The fundamental cause of a venous ulcer is sustained high pressure in the leg veins. When the valves that prevent backflow become weakened or damaged, blood flows backwards (reflux), increasing the pressure on the skin. Over time, this makes the skin fragile and prone to breaking open even after a minor knock or scratch.

Common risk factors identified by NICE (National Institute for Health and Care Excellence) include:

• A history of Deep Vein Thrombosis (DVT) or leg fractures.
• Varicose veins, which indicate failing valves.
• Obesity, which increases the pressure on the lower limb vascular system.
• Reduced mobility, as the 'calf muscle pump' is essential for moving blood upwards.
• Pregnancy or a history of multiple births.
• Increasing age, as tissues and vessels naturally lose elasticity.

Treatment for chronic venous ulcers in the UK follows a standardised clinical pathway designed to reduce pressure and promote tissue regeneration. The primary pillars of treatment are:

1. Cleaning and Dressing

A healthcare professional will clean the ulcer to remove dead tissue and debris. A non-adherent dressing is then applied to manage discharge and protect the wound from infection.

2. Compression Therapy

This is the 'gold standard' for venous ulcer care. Specially designed compression bandages or stockings are used to apply pressure to the leg, assisting the veins in moving blood back to the heart. This reduces the internal pressure at the site of the ulcer, allowing it to heal.

3. Lifestyle Modifications

Patients are encouraged to keep their legs elevated above the level of the heart when resting and to stay as active as possible. Walking helps activate the calf muscle pump. Managing weight and quitting smoking are also crucial for improving vascular health.

Living with a chronic condition can be challenging, but you can speak to a GP online to help manage your symptoms and treatment plan. While the physical dressing of the wound often requires an in-person nurse visit, an online doctor can provide essential support in the following ways:

• Initial Assessment: Discussing your symptoms and medical history to determine if a leg sore requires urgent investigation.
• Treatment Advice: Providing evidence-based guidance on compression garments and skin care routines.
• Medication Management: Prescribing treatments for associated symptoms, such as steroid creams for venous eczema or paracetamol for pain management.
• Sick Notes: If your ulcer significantly affects your ability to work, a GP online can provide a FIT note.
• Referral Guidance: Advising on when you might need a referral to a vascular specialist for surgical intervention on varicose veins.

Once a venous ulcer has healed, the risk of recurrence is high. Statistics suggest that up to 25% of healed ulcers may return within a year if preventative measures are not taken. Long-term management involves wearing compression stockings indefinitely, even after the skin has closed. Keeping the skin moisturised with emollients helps prevent the dryness and cracking that can lead to new wounds.