Venous Leg Ulcer: Causes, Symptoms, Treatment, and Management
Overview of Venous Leg Ulcers
Venous leg ulcers are chronic, non-healing wounds that develop due to poor venous circulation. They are the most common type of leg ulcer and are primarily caused by chronic venous insufficiency (CVI). If left untreated, venous ulcers can lead to severe complications, recurrent infections, and impaired mobility. Early diagnosis and appropriate treatment can significantly improve healing outcomes.
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Conventional treatment methods include cleansing the wound, applying dressings, and using compression bandaging. However, since leg ulcers tend to heal slowly, this approach can significantly affect the patient's quality of life.
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At Dr. Soroush Sohrabi's clinics in Dubai, patients undergo a comprehensive assessment to identify the circulatory causes of leg ulcers and determine whether venous insufficiency is the underlying issue. A range of advanced treatments, including laser and radiofrequency ablation, sclerotherapy, ClariVein®, TRLOP, and phlebectomy, are tailored to each patient’s specific needs, ensuring effective and personalised care for optimal treatment outcomes.
Understanding Venous Leg Ulcers
What is a Venous Leg Ulcer (Sore)
A venous leg ulcer is an open wound that fails to heal or has a heals very slowly, typically occurring on the lower leg, above the ankle. These ulcers develop due to increased venous pressure, which causes skin breakdown and impaired healing.
How Do Venous Leg Ulcers Develop
Venous leg ulcers form when the veins in the legs fail to return blood efficiently to the heart, causing blood to pool in the lower extremities. This leads to tissue damage and skin breakdown, resulting in ulcer formation.
Causes of Venous Leg Ulcers
Your heart pumps oxygen- and nutrient-rich blood through the arteries to various parts of your body, including your legs. For circulation to be complete, this blood must return to the heart and lungs for re-oxygenation via the veins. However, unlike the arteries, the veins in your legs do not have a built-in pump like the heart. Instead, blood must travel upwards against gravity, which naturally pulls it back down.
The movement of blood from the legs relies on the action of your leg muscles. When you walk or move, your muscles contract, squeezing the veins and pushing blood upward. To prevent backflow when the muscles relax, one-way valves within the veins close, ensuring blood moves in the right direction.
If these valves become damaged or weakened, they can no longer prevent blood from flowing backward. This results in blood pooling in the veins, increasing pressure, and causing them to enlarge—leading to varicose veins. This condition, known as "venous insufficiency", is the primary cause of varicose veins.
With time this leads to tissue damage and skin breakdown, resulting in ulcer formation.
Venous Valves
Chronic Venous Insufficiency (CVI)
Risk Factors for Venous Leg Ulcers
The risk factors for venous leg ulcers closely resemble those for varicose veins. Chronic venous insufficiency leads to progressive skin damage, eventually resulting in leg ulcers.
Gender
Women are more likely to develop venous leg ulcers than men due to hormonal changes during puberty, pregnancy, and menopause, which weaken vein walls and valves, leading to blood pooling. Hormonal contraceptives and hormone replacement therapy (HRT) can further increase the risk. Although men can also develop venous insufficiency, the condition is more common in women due to the effects of estrogen and progesterone on vein elasticity and circulation.
Excess weight
​Excess weight increases pressure on veins, weakening their walls and valves, leading to blood pooling and venous insufficiency. Managing weight can help reduce the risk and improve vein health.
Job, lifestyle, prolong sitting and standing
Movement supports healthy blood flow, while prolonged sitting can slow circulation. On the other hand, standing for long periods makes it harder for blood to flow upward, as it must work against gravity.
Family history / genetics
Genetics are a major risk factor for venous insufficiency, as a family history increases the likelihood of developing the condition. Weak vein walls and valves can be inherited, leading to blood pooling and skin ulceration over time.
Deep vein thrombosis (DVT)
Formation of clot in the deep veins will significantly increase the risk of developing venous insufficiency.
Smoking
Smoking tobacco is known to narrow blood vessels, restricting circulation and impairing blood flow to the legs. Studies indicate that smoking can also slow the healing process of leg ulcers, increasing the risk of complications and prolonged recovery.
Symptoms of venous leg ulcers
Common symptoms of venous leg ulcers
Venous leg ulcers typically appear as shallow, irregularly shaped wounds with a red or yellow base, most commonly located on the lower leg, just above the ankle. They are often accompanied by swelling in the feet and ankles, skin discolouration (brownish pigmentation), and itchiness due to chronic venous insufficiency. These ulcers may be associated with varicose veins, further contributing to venous congestion and impaired healing. Commonly there are thread veins in the legs as well. Patients often experience mild pain or discomfort, which worsens with prolonged standing. Additionally, fluid leakage from the ulcer can lead to weeping or crusting, increasing the risk of infection and delayed wound healing.
When to see a doctor for venous leg ulcers
If you have a non-healing or slow-healing ulcer on your leg, it is important to consult a doctor for a proper assessment. The location, shape, and depth of the ulcer, along with skin changes, swelling, and the presence of varicose veins, can provide key insights into its underlying cause. Seeking medical attention is essential to prevent complications and ensure appropriate treatment for effective healing.
Diagnosis Of Leg Venous Ulcers
Clinical Examination and Medical History
A thorough clinical assessment is essential to determine whether a leg ulcer is caused by chronic venous insufficiency. The location, shape, and depth of a venous leg ulcer help in its diagnosis, as these ulcers are typically shallow with irregular edges and most commonly found on the lower leg, above the ankle. Skin changes such as swelling, skin discolouration, and venous eczema are common signs of chronic venous insufficiency, which is the primary cause of venous ulcers. The presence of varicose veins further indicates underlying venous insufficiency, contributing to poor circulation and delayed healing. Additionally, a history of deep vein thrombosis (DVT), leg trauma, varicose veins, or prolonged leg swelling increases the risk of developing venous leg ulcers, making an accurate diagnosis essential for effective treatment.
Diagnostic tests
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Doppler Ultrasound – A non-invasive test that checks for blocked or weak veins by using sound waves.
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Ankle-Brachial Index (ABI) – A simple test to compare blood pressure in the ankle and arm to see if there are artery problems.
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CT Venography (CTV) – A scan that uses contrast dye to create detailed images of deep veins and check for blockages.
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Venography – A special X-ray test with dye to see veins more clearly, used when other tests don’t give clear results.
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Skin Biopsy – A small sample of skin taken from the ulcer to check for diseases like cancer or inflammation.
Treatment Of Leg Venous Ulcers
Compression therapy
Compression therapy is essential for improving circulation and reducing swelling.
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Compression stockings are not suitable for patients with peripheral arterial disease (PAD) unless carefully assessed. They should only be worn with caution and under medical supervision after evaluating arterial flow and circulation, as they may further restrict blood supply to the legs. If you have been diagnosed with PAD, have a history of diabetes, or are a smoker, it is important to consult your doctor before using compression therapy. Dr Soroush Sohrabi, an experienced vascular surgeon, specialises in arterial disease and can assess your vascular health, diagnose peripheral arterial disease, and provide expert guidance on whether compression therapy is suitable for you.
Wound Care & Dressings
Proper wound management promotes healing and prevents infection:
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Regular wound cleaning
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Moist or antimicrobial dressings
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Debridement to remove dead tissue
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Antibiotics for infections
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Topical steroids for venous eczema
Minimally Invasive Treatments
The minimally invasive treatments available at Dr. Soroush Sohrabi Clinics in Dubai include laser and radiofrequency ablation, ClariVein®, micro phlebectomy, TRLOP, and sclerotherapy. These advanced procedures effectively target venous insufficiency, improve circulation, and promote healing with minimal downtime. Please visit the individual treatment pages for more detailed information.
Prevention & Lifestyle Modifications
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Regular exercise & leg elevation
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Wearing compression stockings
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Healthy diet & hydration
Expert Care for Venous Leg Ulcers in Dubai – Restore Your Skin & Vascular Health
"Venous leg ulcers are a common and challenging complication of chronic venous insufficiency. However, with early diagnosis, proper wound care, compression therapy, and, if necessary, minimally invasive treatments, they can be effectively managed. Consulting a vascular specialist ensures the best approach for long-term healing and prevention of recurrence. Book a consultation at Dr. Soroush Sohrabi Clinics in Dubai for expert assessment and personalised treatment options."