Leg ulcer, venous - Treating a venous leg ulcer

With appropriate treatment, most venous leg ulcers will heal within three to four months.

Treatment should always be carried out by a healthcare professional trained in compression therapy for leg ulcers. Usually, this will be a practice or district nurse.

Cleaning and dressing the ulcer

The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This will provide the best conditions for the ulcer to heal.

A simple, non-sticky dressing will be used to dress your ulcer. This will usually need to be changed once a week. Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.

Compression bandages

To help improve the circulation in your legs, your nurse will need to apply a firm compression bandage over the affected leg. These bandages are designed to squeeze your legs and encourage blood to flow upwards, towards your heart.

There are many different types of bandage used to treat venous leg ulcers, which can be made up of two, three or four different layers. The application of a compression bandage is a skilled procedure and should only be done by a healthcare professional trained in leg ulcer management.

Bandaging of the leg is usually done after the ulcer has been dressed. The bandage is changed once a week, when the dressing is changed.

When compression bandages are first applied to an unhealthy ulcer, it usually becomes more painful. Ideally, you should have paracetamol or an alternative painkiller prescribed by your GP. The pain will lessen once the ulcer starts to heal, but this can take up to 10-12 days.

It’s important to wear your compression bandage exactly as instructed by your nurse. If you have any problems, it's usually best to contact your nurse, instead of trying to remove it yourself. If the compression bandage feels a little too tight and is uncomfortable in bed at night, getting up for a short walk will usually help. 

However, if you get severe pain at the front of your ankle or on the top of your foot, or if your toes become blue and swollen, you will need to cut the bandage off. Once you remove the bandage, make sure you keep your leg highly elevated and contact your nurse as soon as possible.

Treating associated symptoms

Swelling in the legs and ankles

Venous leg ulcers are often accompanied by swelling of your feet and ankles (oedema), which is caused by fluid build-up. This can be controlled by compression bandages.

Keeping your affected leg elevated whenever possible, ideally with your toes at the same level as your eyes, will also help ease swelling. You may find it helpful to put something firm – such as a rigid suitcase – under the end of your mattress, to help keep your legs raised while you sleep.

You should also keep as active as possible and aim to continue with your normal activities. Regular exercise, such as a daily walk, will help reduce leg swelling. However, you should avoid sitting without your legs raised or standing still for longer than an hour at a time.

Itchy skin

Some people with venous leg ulcers develop rashes with scaly and itchy skin.

This is sometimes caused by a condition called varicose eczema, which can be treated with a moisturiser (emollient) and occasionally a mild corticosteroid cream or ointment. In severe cases, you may need to be referred to a dermatologist (skin specialist) for treatment.

Itchy skin can also sometimes be caused by an allergic reaction to the dressings or creams applied by your nurse. If this happens, you may need to be tested for allergies.

It’s important to avoid scratching your legs if they feel itchy, because this could damage the skin and lead to further ulcers.

Looking after yourself during treatment

To help your ulcer heal more quickly, follow the advice below:

• Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse.
• Whenever you are sitting or lying down, try to keep your affected leg elevated.
• Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation.
• Stop smoking, eat a healthy diet and moderate your alcohol consumption. This can help the ulcer heal faster.
• Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear.

You may also find it helpful to attend a local healthy leg club, such as those provided by the Lindsay Leg Club Foundation, for support and advice about living with a leg ulcer.

Treating an infected ulcer

An ulcer will sometimes produce a large amount of pus and become more painful. There may also be some redness around the ulcer. These symptoms may be a sign of infection.

If your ulcer becomes infected, it should be cleaned and dressed as usual, although you may need to stop wearing your compression bandage until the infection has cleared.

You should also keep your leg elevated whenever possible, and you will be prescribed a seven-day course of antibiotics.

The aim of antibiotic treatment is to heal the infection. However, they have no beneficial effect on ulcer healing and should only be used in short courses, in order to treat ulcers that have become infected.

Follow-up

You should visit your nurse once a week to have your dressings and compression bandages changed. They will also monitor the ulcer to see how well it is healing. Once your ulcer is healing well, you will probably need to see your nurse less often.

After the ulcer has healed

Once you have had a venous leg ulcer, there is a significant chance another ulcer could develop within the next few months or years.

The most effective method of preventing this is to wear compression stockings at all times when you are out of bed. Your nurse will help you find a stocking that fits correctly and that you can manage yourself.

Various accessories are available to help you put them on and take them off.

Read more about preventing venous leg ulcers.