Venous Leg Ulcers — Why Do They Develop?
Emergency Warning
Seek emergency care immediately — call 995 or go to the nearest A&E — if you have sudden leg swelling with chest pain or breathlessness, or if a leg becomes severely painful, pale or cold. These can be signs of a serious clot.
A venous leg ulcer is an open wound that develops when the skin and underlying tissues are damaged by long-standing chronic venous disease. Most venous ulcers occur around the inside of the ankle (medial malleolus), where venous pressure is highest. They represent the most advanced stage of chronic venous disease.
Venous leg ulcers do not develop suddenly. They are usually the result of years of untreated venous reflux and persistent venous hypertension. When the one-way valves in the leg veins fail, blood flows backwards and pools in the lower leg. The resulting increase in venous pressure affects not only the veins but also the tiny blood vessels (capillaries) that supply oxygen and nutrients to the skin.
Over time, chronic venous hypertension leads to inflammation, leakage of fluid and blood cells into the surrounding tissues, and progressive damage to the skin. As healing becomes impaired, even a minor knock, scratch or insect bite may fail to heal properly and eventually develop into an ulcer.
Early Warning Signs
Before a venous ulcer develops, many patients notice changes in the skin around the ankle, including:
- Persistent ankle swelling
- Brown or reddish skin discoloration (haemosiderin pigmentation)
- Dry, itchy or inflamed skin (venous eczema)
- Thickened or hardened skin (lipodermatosclerosis)
- White scar-like patches (atrophie blanche)
- Slow healing after minor injuries
These changes are warning signs of advanced chronic venous disease and should prompt assessment by a vascular specialist before ulceration occurs.
How Are Venous Leg Ulcers Treated?
Successful treatment involves addressing both the ulcer and the underlying venous disease.
Compression therapy remains the cornerstone of treatment because it reduces venous hypertension, improves venous return and promotes wound healing. Appropriate wound dressings help maintain a favourable healing environment and manage wound exudate.
Equally important is identifying and treating the underlying venous reflux. A duplex ultrasound scan is the gold standard investigation for mapping the venous system and determining whether intervention is appropriate. Modern minimally invasive procedures such as endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemical ablation (MOCA) and cyanoacrylate closure (VenaSeal™) can eliminate the underlying reflux in suitable patients. Clinical studies have shown that treating superficial venous reflux, in addition to compression therapy, accelerates ulcer healing and significantly reduces the risk of ulcer recurrence.
Can Venous Leg Ulcers Be Prevented?
In many cases, yes. Early recognition of chronic venous disease, appropriate use of compression therapy when indicated, and timely treatment of significant venous reflux can reduce the risk of developing venous leg ulcers. Patients who already have ankle swelling, skin pigmentation, eczema or hardened skin should not wait until an ulcer develops before seeking medical advice.
If you have a wound around your ankle that has not healed within two weeks, or if you notice progressive skin changes associated with varicose veins, you should seek prompt assessment by a vascular specialist. Early diagnosis and treatment offer the best opportunity to prevent complications and preserve long-term leg health.