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

A chronic venous leg ulcer is a persistent, long-lasting sore that takes more than two weeks to heal. In the UK, these ulcers are the most common type of leg sore, affecting approximately 1 in 500 people. They occur when high pressure in the veins of the lower legs causes fluid to leak out, damaging the skin and eventually leading to a breakdown in tissue.

Unlike acute wounds, venous ulcers are a symptom of a chronic condition known as venous insufficiency. This occurs when the valves in the leg veins do not work effectively, preventing blood from flowing back up to the heart efficiently. According to NICE guidelines, early identification and management of the underlying circulation issues are critical for successful healing.

Venous ulcers typically develop on the inside of the leg, just above the ankle. Key symptoms include:

• A shallow sore with irregular edges.
• A base that may be covered in yellow-white fibrous tissue.
• Achness or heaviness in the legs, particularly at the end of the day.
• Swollen ankles (oedema).
• Discoloured, hardened, or itchy skin around the wound (varicose eczema).
• Dark brown or reddish patches caused by blood leaking into the skin (haemosiderin staining).

If the ulcer is not painful, it does not mean it is not serious. Many chronic ulcers are relatively painless but require consistent medical intervention to prevent secondary complications.

The primary cause is venous hypertension. When blood pools in the lower legs, the pressure increases. This pressure damages the tiny blood vessels (capillaries) and causes skin inflammation, making it fragile and prone to ulceration.

Factors that increase your risk include:

• Varicose veins: Swollen and enlarged veins that indicate valve failure.
• Previous DVT: A history of deep vein thrombosis can damage leg valves permanently.
• Age and Mobility: Being over 65 or having reduced mobility (which stops the 'calf pump' mechanism) increases risk.
• Obesity: Excess weight increases the pressure on the venous system.
• Previous leg injury: Fractures or surgeries that may have impacted circulation.

Treatment for venous ulcers follows standard NHS pathways, focusing on two main areas: wound care and compression. The most effective treatment is compression therapy, which involves applying firm bandages or stockings to the leg to improve vein function and reduce swelling.

Wound Care

Wounds must be cleaned regularly (debridement) and covered with non-adherent dressings. Dressings are changed weekly or more frequently depending on the amount of fluid (exudate) the ulcer produces.

Compression Bandages

Once an arterial check (using a Doppler ultrasound) has confirmed that your arterial blood flow is healthy, a nurse or GP will apply compression bandages. This is the 'gold standard' for healing venous ulcers. NICE clinical knowledge summaries suggest that compression can significantly reduce healing time compared to dressings alone.

Lifestyle Adjustments

Patients are encouraged to keep their legs elevated above their heart when sitting and to stay as active as possible to encourage healthy circulation.

Managing a long-term condition like a venous ulcer can be challenging. You might choose to speak to a GP online if you need an initial assessment of a new sore, advice on skin changes, or a review of your current management plan. An online consultation is a convenient way to discuss:

• Initial diagnosis and referral pathways for Doppler testing.
• Prescriptions for medicated creams for associated varicose eczema.
• Advice on managing leg swelling (oedema) at home.
• Mental health support if the chronic nature of the wound is affecting your quality of life.
• A second opinion on slow-healing wounds or suspected flare-ups.

While physical wound cleaning and bandaging require in-person nursing care, an online doctor can provide the evidence-based medical oversight needed to manage the systemic causes of the ulcer.

Unfortunately, once you have had a venous ulcer, the risk of recurrence is high. To prevent the ulcer from returning, it is vital to continue wearing compression stockings even after the wound has closed. Regular moisturising of the legs with emollients helps maintain the skin barrier, and maintaining a healthy weight reduces the load on your circulatory system. Consistent follow-up with a healthcare professional ensures that any early signs of skin breakdown are caught before a full ulcer develops.