Leg ulcers: what are they and how do you treat them?

In this section, you’ll learn:

• what a chronic leg ulcer is 
• what the three main types of leg ulcers are and why they form 
• how to identify and manage leg ulcers 

Living with a leg ulcer that won’t heal has significant consequences for a person’s quality of life. As many of you will know from your daily practice, leg ulcers are often painful; they might smell; and they typically reduce a person’s mobility. As a result, this group of patients is under a lot of psychological stress. They are often too embarrassed to go out and suffer from loneliness and anxiety.^{1, 2}

Chronic wounds are a heavy burden on the healthcare system, too. It is estimated that Western countries spend 1% of their healthcare budgets on managing leg ulcers.³

As a healthcare professional, you can help reduce this burden. This section gives you a basic understanding of the different types of chronic leg ulcers and specific guidance on how to manage them.

Achronic leg ulcer is a skin defect located below the knee that continues for more than six weeks and:

• shows no sign of healing after three months of appropriate treatment; or
• hasn’t completely closed after 12 months.⁴

There are three main types of chronic leg ulcers:

• Venous leg ulcers
• Arterial leg ulcers
• Diabetic foot ulcers

Lower limb, or leg, ulcers typically form because of insufficient blood flow in either of the arteries (known as arterial insufficiency) or the veins (known as venous insufficiency). They can also form because of a combination of factors (mixed aetiology), such as both arterial and venous insufficiency, or as a result of other chronic health conditions, such as diabetes.⁴

To find out more about how arterial and venous insufficiency can cause leg ulcers, click here.

The chart below describes the main characteristics for each type of leg ulcer.

Manyfactors can lead to leg ulcers. That’s why you need to take a multidisciplinary approach, e.g. coordinating with specialist nurses, podiatrists, nutritionists, etc., when assessing your patient. This will help you to determine how the disease has developed; make a definitive diagnosis; and develop an optimal treatment plan for your patient.⁴

Once the treatment plan is in place, it’s important to monitor patient progress and adhere to the plan as the ulcer decreases in size. Training and education are also vital for everyone involved in caring for patients with chronic leg ulcers.⁴

There are five key principles to follow when managing leg ulcers:³

1. find out what’s causing the wound (i.e. its aetiology);
2. assess the patient holistically;
3. decide if you need to get a referral because of comorbidities;
4. evaluate whether compression therapy is a suitable option for the patient; and
5. gather relevant information for appropriate wound management.

If you’re looking for more specific details on how to manage venous leg ulcers, please click here.