Medically reviewed by Dr. A.M. van Coevorden, dermatologist
Leg ulcerA wound on the lower leg that will not heal.
A leg ulcer, in Dutch known as an open been or ulcus cruris, is a wound on the lower leg that does not heal within a few weeks. The cause usually lies not in the wound itself but in the circulation: poorly working valves in the veins let fluid accumulate, making the skin fragile so that a small wound can grow into an ulcer. Leg ulcers mainly affect older people, often after years of varicose veins. Treatment revolves around external pressure: bandages or stockings.
What is a leg ulcer?
A leg ulcer usually develops around or just above the ankle. Years of symptoms often precede it: heavy, tired legs, fluid in the lower legs, itching, eczema and a brown discolouration of the skin. The skin there becomes thin and fragile; a knock or scratch is then enough to create a wound that will not close, or the wound appears spontaneously. The wound can leak fluid and be painful. Without treatment of the cause, a leg ulcer persists for months.
How does a leg ulcer develop?
The veins in the legs contain valves that send the blood towards the heart. If those valves work poorly, for instance through varicose veins or after a thrombosis, blood sinks back and fluid accumulates in the lower leg. Under that constant pressure the skin receives too little oxygen and nutrients and its quality declines, until a wound forms. This is called a venous ulcer, by far the most common form. Sometimes the supply through the arteries is the problem instead; that requires a different treatment, which is why the doctor always investigates the cause first.
What can you do yourself?
Move a lot: with every step the calf muscles pump the blood upwards, and that is exactly what the leg needs. Elevate the legs when sitting or resting. Wear the prescribed compression stockings or bandages day in, day out; they deliver the pressure that carries the healing. Keep the skin around the wound supple with a neutral cream and do not scratch itchy areas. If you notice fluid, a brown discolouration or eczema on the lower legs while there is no wound yet: that is the moment to have varicose veins assessed and stay ahead of a leg ulcer.
Bandages and compression stockings only really work in combination with movement: the external pressure and the pumping power of the calf muscles together form the treatment. Walking a lot is not a side note but part of the therapy.
When to see a dermatologist or doctor?
Any wound on the lower leg that does not heal after two to three weeks belongs with the GP. The GP investigates the cause, if needed with an ultrasound of the blood vessels, and starts the treatment: compression with bandages or a compression stocking, wound care, and treatment of the varicose veins to prevent recurrence. Healing takes weeks to months and regular check-ups. Make contact sooner if the wound quickly becomes larger, more painful or dirtier, or with fever. A dermatologist can review skin problems around the wound online, such as eczema or discolouration; the wound treatment itself is hands-on care via the GP, wound care nurse or a dermatologist in your region.
Please note
A wound on the lower leg that does not close after two to three weeks is not an ordinary wound. Have it assessed: the sooner the cause is treated, the faster the healing.
Frequently asked questions
Why does a leg ulcer heal so poorly?
Because the cause lies in the circulation: as long as fluid keeps accumulating in the lower leg, the skin receives too little oxygen and nutrients to recover. That is why treatment targets the pressure in the leg, with bandages or stockings, and not just the wound itself.
How long does a leg ulcer take to heal?
Count on weeks to months, depending on the size of the wound and the cause. With good compression therapy and wound care, the majority of venous leg ulcers heal. Faithfully wearing the bandages or stockings and moving a lot speed up recovery.
Does a leg ulcer come back?
Without treatment of the cause, that chance is high: the weak valves remain, after all. That is why varicose veins are often treated and compression stockings stay necessary after healing. This makes a new leg ulcer much less likely.
Does compression bandaging really help?
Yes, compression is the core of the treatment for a venous leg ulcer. The external pressure helps the fluid out of the leg and improves the blood flow back, allowing the skin to recover. The bandage is reapplied several times a week and works best in combination with plenty of walking.
When should you see a doctor about a wound on the lower leg?
If the wound does not heal after two to three weeks, and sooner if it quickly becomes larger, more painful or dirtier or if you develop a fever. Even without a wound, fluid, brown discolouration or eczema on the lower legs are a reason to have the blood vessels assessed.
Sources and more information
- Open been - Ulcus cruris venosum (nvdv.nl)
- Ik heb een open been (thuisarts.nl)