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Why do leg ulcers develop?
These are mainly due to:
Venous insufficiency (that is badly functioning veins)
Arterial insufficiency (blocked arteries)
Peripheral neuropathy (impaired sensation, most commonly seen in diabetes)
There are other less common causes but the vast majority of leg ulcers are due to one or a combination of these three problems. The "mixed" ulcers (i.e. due to more than one factor) are more difficult to cure and are more likely to recur.
If an ulcer is very painful, especially if the pain is worse at night and relieved by hanging the leg down, it is likely there is an underlying arterial problem limiting the flow of blood into the leg. By contrast, legs with chronic venous insufficiency feel more comfortable elevated up on a stool or in bed. Neuropathic ulcers are usually painless.
Treatment of a leg ulcer requires more than dressings, but also correction of the underlying cause.
How is the cause of an ulcer established?
Clinical assessment by a vascular surgeon is required to confirm the underlying cause of a leg ulcer. Duplex scanning of the arteries and veins in the affected limb are usually accurate ways of establishing whether there is a disorder of the circulation underlying the ulcer.
Treatment of ulcers due to artery blockages
An ulcer that is caused by diseased arteries is usually very painful. Ulcerated legs with poor artery blood flow are referred to as being critically ischaemic (i.e.short of blood). Treatment options for this condition are explained in detail in the section of the website devoted to Critical Limb Ischaemia (see Conditions Treated, Prevented and Cured).
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