Leg ulcers

Leg ulcers are ulcers on the feet or lower legs that do not heal within six weeks. The most common cause of leg ulcers is that the blood circulation in the legs does not work properly. Most people get rid of their leg wounds but it can take a long time, sometimes several years.

Different types of leg ulcers

Leg ulcers are due to the blood circulation in the legs being impaired. This makes it easier to get wounds. In addition, the wounds are often difficult to heal due to impaired blood circulation.

There are different types of leg ulcers, but venous leg ulcers and arterial leg ulcers are the most common.

Venous leg ulcers are due to impaired blood flow in the veins. It is the blood vessels that direct the blood to the heart from the various parts of the body. The blood then has difficulty pumping from the legs to the heart and the legs become swollen. This is the most common type of leg ulcer.

Arterial leg ulcers are due to impaired blood flow in the arteries. It is the blood vessels that direct the blood from the heart into the body. The blood is difficult to reach in the body if the arteries have become narrow. The skin then does not get enough oxygen and nutrition.

Sometimes blood circulation is impaired in both the veins and arteries. Then you can get so-called combined leg ulcers.

Symptoms of leg ulcers

Venous leg ulcers often sit on the ankle in connection with the ankles or on the limb, but rarely on the foot. The wounds are usually superficial, irregular in shape and can sometimes hurt.

Arterial leg ulcers usually sit on the foot but can also sit on the lower leg. The wounds are usually covered with a black scab and the foot is often pale and cold. Arterial leg ulcers often hurt a lot, especially when lying down or walking.

When and where should I seek care?

Contact a health care provider if you have any of the following problems:

  • You get a wound on the foot or leg that does not heal within six weeks.
  • You have angina in your legs and you also get a wound.
  • The skin around the wound becomes redder, discolored or irritated and swollen.
  • You have diabetes and get a leg or leg ulcer.

You can also contact a health care center if you have symptoms that your blood circulation in your legs is impaired. It can be one or more of the following problems in the legs or feet:

  • You get hurt when you walk.
  • You get hurt when you lie down, and it is relieved by the legs hanging down.
  • You are swollen in your legs for a long time.
  • You have a sense of weight that eases when you put your leg high.
  • The foot is often pale and cold.
  • You have brown or purple areas of the skin, especially around the ankle.

If you have leg ulcers and it causes more pain and the swelling and redness increases, contact a health center or on-call reception.

If closed, you can wait until the health center or on-call reception opens. You can contact many receptions by logging in.

If it’s in a hurry

You should seek care directly at a health center or emergency room if you have any of the following problems:

  • The wound hurts a lot.
  • You have pain during the night.
  • You suddenly get a lot of pain at the same time as your leg becomes pale.
  • You have leg ulcers and you get a fever.

Surveys

At the health center, you are examined by a doctor. The doctor does a general body examination, looks at the skin and feels the arteries in the feet. The doctor takes a bacterial sample from the wound using a cotton swab if the wound appears to be infected.

You can get a referral to do a more detailed examination in the hospital. You can also get a referral to a dermatologist or vascular surgeon for specialist assessment if needed. For example, you may be examined with ultrasound, contrast x-ray, magnetic camera or computed tomography.

Treatment of venous leg ulcers

You will be assisted by healthcare professionals to manage your leg ulcers.

Wound dressings

The wound is covered with a bandage that keeps it moist. Then the wound heals faster. When a new bandage is tested, it is changed twice a week. The dressing may need to be changed every day if a lot of fluid comes from the wound. Eventually, it is rarely changed so that wound healing is not disturbed.

The wound is cleaned when the dressing is changed. Sometimes it may need to be cleansed from dead tissue and skin flakes. In order not to hurt, you can get anesthetic gel on the wound before.

The legs are wound to reduce the swelling

In order for the wound to heal, the blood must be helped to circulate from the bone so that the swelling goes down. Then you get so-called compression treatment. This means that you are wrapped with elastic bandages or may use special compression stockings. Compression treatment reduces swelling in the legs. In addition, the calf muscles receive support from the outside so that they can function more effectively. You need to try compression socks at a district nurse so you get a pair that presses hard enough.

Most leg ulcers heal if the legs are wound properly, but it can be difficult. Therefore, it is usually the care staff that winds up. Sometimes you or yourself or a relative can learn how to do it. The type of bandage and winding that is best depends on what trouble you have and how the wound looks.

Some bandages are removed before going to bed and wrapped again before rising. Others are wrapped one to three times a week, and then you have them even at night.

Some must continue to use bandages or compression stockings every day even after the wounds have healed so as not to get new wounds. Many people find it nice because the swelling in the legs decreases.

You can wear plain clothes outside the bandages and compression stockings.

If you are in pain

Sometimes venous leg ulcers can hurt, and the pain, in turn, can prevent wound healing. To relieve the pain, you can try non-prescription drugs containing paracetamol, such as Clevedon or Panadol. You can also use a type of analgesic and an anti-inflammatory drug called NSAID or cox inhibitor. For example, you can take medicines containing ibuprofen, such as Ipren or Ibumetin.

You should use acetaminophen instead of ibuprofen or any other NSAID if you are over 75, have any cardiovascular disease or have previously had a stomach ulcer.

The doctor can prescribe prescription painkillers if prescription drugs do not help. It is important to get treatment if you are in pain.

The pain can also be temporarily relieved by covering the wound with a special gel containing anesthetics, such as EMLA or Xylocaine. Such a gel can be good to use if it hurts a lot when the wounds are applied. There are also several other dressings and gels that can also relieve the pain.

varicose vein surgery

The risk of venous leg ulcers is increased if you have varicose veins. Then you need to be operated to avoid getting new leg ulcers. The operation can also mean that you do not have to use bandages or support socks after the leg wound has healed.

Skin grafting

Skin transplantation is usually used only after an operation of varicose veins if the wound is still not healing or very large. The operation can be done at a health center and is called pinch graft. You get local anesthesia and the doctor removes thin small pieces of skin from another part of the body, usually from the thigh, and places them in the wound. The wound can then heal faster, as it will help healthy skin cells to cover the wound surface.

Treatment of arterial leg ulcers

You will be assisted by healthcare professionals to manage your leg ulcers.

Wound dressings keep wounds dry

The wounds are kept dry and clean with the help of special dressings. Because it can be difficult to wrap properly, it is usually done by healthcare professionals. Sometimes the dressing can make it more painful, so you have to take it off.

If you are in pain

Arterial leg ulcers often hurt, but you can get medicines that help with the pain. First, you can try for yourself with non-prescription drugs containing paracetamol, such as Clevedon or Panadol. You can also use painkillers and anti-inflammatory drugs called NSAIDs or cox inhibitors. For example, you can take medicines containing ibuprofen, such as Ipren or Ibumetin.

You should use acetaminophen instead of ibuprofen or any other NSAID if you are over 75, have any cardiovascular disease or have previously had a stomach ulcer.

The doctor can prescribe prescription painkillers if prescription drugs do not help. It is important to get treatment if you are in pain.

The pain can also be temporarily relieved by covering the wound with a special gel containing anesthetics, such as EMLA or Xylocaine. Such a gel can be good to use if it hurts a lot when the wounds are applied. There are also several other dressings and gels that can also relieve the pain.

It can hurt less if you have low legs. At night, you can try raising the head end of the bed by, for example, placing bricks under the bed legs so that your feet end up a little lower than the head. A motor-driven bed where the head and foot ends can be raised or lowered can facilitate.

You receive treatment for other diseases

You will receive treatment with medicines and instructions on how to eat and exercise if you have high blood pressure and high levels of blood fat. You also receive treatment for other illnesses or disorders that can impair blood circulation, such as heart failure. It is common to get tablets that prevent blood clots from forming.

You may need surgery

The constrictions in the arteries are operated if possible, either with so-called balloon enlargement or with a larger vessel operation. After the treatment, the leg ulcers usually heal within three to four weeks. It can take longer, for example, if the wounds are large or if you have diabetes.

Treatment of infected wounds

The wound can smell bad if there is a lot of bacteria in it. There are special compresses with carbon or iodine that can help with the smell. Sometimes wraps or ointments are used with acetic acid, which prevents bacteria from thriving. The treatment may burn a little, but it will soon be over.

The wound can become infected. The sign of this is that the skin around the wound becomes redder and hurts more than before and the area is swollen and feels warm. Another symptom of infection may be a fever. Then you may need antibiotics or other treatment.

You should avoid exercising if you have an infected leg ulcer.

What can I do for myself?

It is very important to stop smoking if you do. Smoking means that it takes longer for wounds to heal. You can get help from health care if you have a hard time quitting smoking on your own. Some district nurses have specialized training to help with this and you may be able to join a quit smoking group.
Here you can read about help to quit smoking.

It is important to eat a nutritious diet that contains enough protein, iron, and vitamins to improve wound healing.

Be sure to keep your feet clean and lubricate them with softening ointment or cream. This reduces the risk of dry skin and self-cracks.

It is good to have spacious shoes that do not scratch or press anywhere. You can get so-called orthopedic shoes if needed. They are specially made to fit well on the foot. You can get a referral from a health center to try out orthopedic shoes. In some cases, you may be eligible for the cost.

When you have venous leg ulcers

It is good to try to lose weight if you are overweight. A heavy body increases the load on the veins in the lower legs and makes the calf muscles harder to push the blood upwards.

By walking and moving on a regular basis, you keep the muscles in the calf active and facilitate blood flow back to the heart. It is good to touch your feet in circles and tilt them up and down as you sit down. It may help to keep your legs high while sitting or lying down to help the blood flow from your legs. Avoid sitting cross-legged as it makes it harder for blood to circulate in the veins.

The risk of getting leg ulcers increases if you have been swollen in your legs for a long time. Then it is good to use support socks that reduce and prevent swelling in the legs. Support socks you can buy at a pharmacy.

When you have arterial leg ulcers

You should try to reduce the risk of arteriosclerosis. By exercising regularly, eating less sugar and fat as well as eating lots of fruits and vegetables, you can reduce the risk of high blood fat levels. Moving is also good as it can cause more new blood vessels to form in the legs.

It is important to have good blood glucose control if you have diabetes. You should get help lowering blood pressure if it is high.

What is due to leg ulcers?

When a wound heals, the damaged skin first becomes red, swollen and sore. It is common for the wound to become fluid. The damage is repaired by dividing the skin cells and the new cells grow over the injury. New blood vessels are formed that grow into the newly formed tissue. However, if the blood circulation is impaired, this usually does not happen, and the wound becomes difficult to heal.

Impaired blood flow in the veins

The blood vessels that bring the blood back to the heart from different parts of the body are called blood vessels or veins. In order for blood to be brought back to the heart from the feet and legs, it must flow upwards into the body. Therefore, the muscles of the calf must first pump the blood upwards. As you move the legs, the muscles alternate around the veins in the leg, and alternately they relax. The contractions cause the blood to be squeezed from the legs up to the heart.

To prevent the blood from flowing back, there is a system of flaps in the veins that help the blood flow to the heart every time a portion of the blood is brought up.

Poor blood flow in the veins due to leaky flaps can cause inflammation of the skin and subcutaneous fat. Then the skin becomes brittle and thin. The wounds do not occur infrequently after you have struck something.

Causes of impaired blood flow in the veins

There can be several different causes of blood circulation problems in the veins. It is common for the problems to be hereditary.

The vein flaps may be more difficult to hold tightly as you get older. The blood may then leak back into the veins and remain in the leg. The calf muscles can also become weaker so that they do not cope with pushing the blood upwards.

You can get damage to the small blood vessels if you have had a job where you have been standing still for a long time. This is because the pressure increases in the veins when standing still.

During pregnancy, the veins are extra strained, as they have to carry more blood.

The pressure from the top that loads the veins is higher if you are overweight.

A more uncommon cause of impaired blood flow to the heart is when a blood clot has damaged the vein valves or clogged the deep veins in the leg.

Impaired blood flow in the arteries

The blood vessels that carry the blood from the heart into the body are called arteries or arteries. The blood cannot reach the body as it should if the arteries for any reason become too narrow or clogged.

The skin then does not get the nutrition and oxygen it needs and becomes brittle and thin. The wounds can occur after, for example, pressing for tight shoes or after hitting something.

Causes of impaired blood flow in the arteries

The most common cause of arterial blood flow is arteriosclerosis, also called atherosclerosis. The blood vessels then become narrow and the blood becomes more difficult to pass through. More unusual causes are inflammation or injury after an accident.

The vast majority of people with vein obesity smoke. The risk of atherosclerosis also increases as you get older, if you have diabetes, high blood pressure or elevated blood fat levels.

Severe leg ulcers can also have other causes, often a combination of different diseases. Sometimes, leg ulcers can occur without the blood flow deteriorating, for example after an injury or skin disease, but it is more uncommon.

Can also lead to angina in the legs

You may get angina in the legs if the blood circulation in the arteries is impaired. It is sometimes referred to as window-tapping. Then you often get very sore legs, usually the calf muscles, when walking. Because leg cramps can often be improved through exercise, it is still important to try to walk regularly. It is not dangerous that it hurts your legs. The risk of leg ulcers is small but increases if the disease gets worse and you get pain even at rest.

Complications

Eczema of poor blood circulation in the veins

You can easily get eczema on the legs if the blood circulation in the veins is impaired or if the legs are very swollen. Therefore, it is important to take good care of the skin, for example lubricating with softening cream or ointment after showering or bathing. If the skin itches, you can use cortisone cream to reduce itching.

Eczema can also be caused or exacerbated by you being allergic to any substance in, for example, pulp, bandage or creams that are part of the treatment.

Sometimes eczema can spread to other parts of the body. You can get a referral to a dermatologist if you have troublesome leg ulcers and skin problems.

Rose fever in venous leg ulcers

You can get an infection called rose fever. The leg then becomes red, swollen and it hurts more and more. It is also common to have a fever. Rose fever needs to be treated with antibiotics.

Vomiting unless arterial leg ulcers heal

There is a risk of cold sores if the wounds do not heal, for example, if they are unable to operate or if you get an infection. Then the foot or leg may need to be amputated, but this is unusual.

Living with leg ulcers

It is good if you can socialize with others so that you do not isolate yourself, as it can make the situation feel even more difficult. One reason why some avoid contact with others may be that the wounds smell bad. You can reduce the hassles by cleaning the wounds and using special dressings that prevent bad odors.

Tell your doctor or nurse how you are feeling so you can get the support and help you need.

Influence and participate in your care

You can seek care at any medical center or open specialist clinic you want throughout the country. Sometimes a referral to the open specialist care is required.

You should understand the information

In order for you to be involved in your care and treatment, it is important that you understand the information you receive from the healthcare personnel. Ask questions if you don’t understand. For example, you should get information about treatment options and how long you may have to wait for care and treatment.

Your consent is important

Once you have received information about what options and options for the care you have, you can give your consent or in some other way express a yes. This also applies to you who are not of legal age.  

You may choose not to give your consent to the care you are offered. You may also withdraw your consent at any time.

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