Overview of Venous Ulcers

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Venous ulcers are shallow wounds or sores caused by circulation (blood flow) problems. They typically form over a bony area of the leg, such as the ankle. Circulation problems result from leg veins that fail to send blood back toward the heart, a condition called venous insufficiency.

Venous ulcers start as a dark or red area that can become thickened, dry, itchy, or tingly. Without treatment, an open wound (ulcer) may form.

This article reviews the symptoms, causes, diagnosis, and treatment of venous ulcers.

Woman wrapping her lower leg with an Ace bandage
zlikovec / Getty Images

Symptoms

An early sign of a venous ulcer is the darkening or reddening of an area of skin on the leg. It is most often over a bony area like the ankle. The skin may also become thick, dry, itchy, or tingly. Without treatment, an ulcer, which is an open, shallow wound, may form.

Venous ulcers often cause a dull ache or pain in the legs and swelling that subsides with elevation. If an ulcer develops, it usually has the following characteristics:

  • Shallow sore
  • Uneven shape
  • Well defined borders
  • Red at the base and may be covered with yellow tissue
  • Surrounding skin is often tight, shiny, warm, and discolored

Infected Venous Ulcer

Call your healthcare provider if you have signs or symptoms of an infection, including:

  • Foul odor from the ulcer
  • Pus coming from the wound
  • Increased drainage
  • Drainage that is yellow or cloudy
  • Bleeding from the wound
  • Redness, swelling, or warmth around the ulcer
  • Fever or chills
  • Increased pain

Causes

Venous ulcers are the most common type of leg ulcer and 1%–3% of the U.S. population has one. The primary risk factors are older age (over 55), obesity, previous leg injuries, deep venous thrombosis, and inflamed veins.

Risk of developing venous ulcers is increased by:

  • Blood clotting disorders
  • Pregnancy
  • Obesity
  • Family history of varicose veins (enlarged, dark colored veins with a cord-like appearance)
  • Chronic venous insufficiency
  • History of pulmonary embolism (clot or blockage in a lung artery)
  • Smoking
  • Excessive alcohol use
  • Poor nutrition
  • Excessively long periods of inactivity or standing
  • Recent operative (surgery) procedures
  • Lower-extremity skeletal or joint disease

Diagnosis

Diagnosis begins with a physical examination and taking a medical history. A healthcare provider may diagnose a venous ulcer if the wound has an irregular shape, is shallow, has well-defined borders, and is over a bony area.

A provider will also look for other signs of venous disease, including varicose veins, swelling in the legs or ankles, decreased lower extremity circulation, and venous dermatitis (a skin condition caused by insufficient blood flow to the area).

While venous ulcers are the most common type of ulcer on the legs, your provider will also rule out other causes. These include complications from diabetes (diabetic pheripheral neuropathy) or skin cancer.

Your healthcare provider may also use an imaging test called an ultrasound (noninvasive imaging test). A biopsy (removing a small tissue sample for analysis in a lab) may be needed if the wound is not healing or looks atypical.

Treatment

Treating a venous ulcer requires the use of various methods to improve circulation. Treatment starts out conservatively and will likely include compression therapy and elevating your legs.

Compression Therapy

Compression therapy is the standard treatment for venous ulcers, It improves chronic venous insufficiency and reduces pain and swelling. Compression therapy includes the following:

  • Elastic bandages: These bandages conform to the shape and size of the leg. They can be worn during rest and while walking. Typically, they are changed about once a week.
  • Inelastic compression wraps: These are used during ambulation (walking or activity). They are not intended for nonambulatory people (people who have difficulty walking or cannot walk). They are often infused with zinc oxide due to its skin-soothing effects.
  • Compression stockings: Compression stockings are used for either healing or prevention. They are removed at night and can be washed. They are usually replaced every six months because the washing slowly causes them to lose compression.

Preventive Compression After Healing

After an ulcer has healed, lifelong maintenance of compression therapy may reduce the risk of recurrence. This is usually accomplished through compression stockings.

There is also evidence that being active may help prevent venous ulcers from occurring. This is especially true when exercise is done in tandem with compression therapy.

Dressings

Sterile dressings are recommended when the wound is open. The type of dressing varies based on the location, size, presence of infection, cost, allergies, and comfort. Wound care is constantly changing and improving. Your provider may refer you to a wound care specialist so they can treat you with the most up-to-date treatment methods.

Debridement

If venous ulcers become infected or resist healing for longer than six months, more aggressive treatments such as debridement (removing the damaged tissue) may be considered. Debridement is used to speed up wound healing through the removal of dead or infected tissue.

Types of debridement include:

  • Surgical
  • Enzymatic (topical, on the skin application)
  • Larval (maggots)
  • Mechanical (wet-to-dry dressings, pressurized water therapy, irrigation)

Leg Elevation

Keeping your legs elevated helps increase blood flood flow and reduce venous pressure. One study has shown that leg elevation used with compression for at least one hour a day and six days per week helped with venous ulcer healing.

Surgery

Surgery for venous ulcers may include vein ablation to correct damaged valves in the vein, reduce varicose veins, increase healing, and help prevent recurrence. Vein ablation cauterizes (burns) and closes off veins. It is minimally invasive. It is done under a local anesthetic (skin-numbing injection). The healthcare provider inserts a small catheter in the vein and uses laser therapy to help heal the vein.

Skin grafting is reserved for wounds that aren't healing well or are large (greater than 25 centimeters). This procedure involves taking healthy skin from one area of a person's body and covering a damaged area.

Medications

Sometimes medications are required to treat venous ulcers. The type of medication depends on the underlying problem. For example, antibiotics may be used for an infection, while other medications may be used to improve vein health or function. The following are medications that your provider may prescribe to help treat venous ulcers:

  • Aspirin is sometimes used as a therapy, but the evidence that it works is inconsistent.
  • Trental (pentoxifylline) increases blood flow and helps with circulation.
  • Statins, such as Zocor (simvastatin), are typically prescribed for high cholesterol but have properties that can help with venous ulcer healing.
  • Antibiotics are a class of drugs that can help heal infected venous ulcers.

Summary

Venous ulcers are shallow wounds or sores on the leg. They typically form over a bony area such as the ankle and are caused by circulation (blood flow) problems. These sores start as a dark or red area and may become thick, dry, and itchy or tingly. Without treatment, an open wound or ulcer may form.

Risk increases with age, pregnancy, chronic venous insufficiency, smoking, a family history of varicose veins, and more. Diagnosis usually involves a history and physical and ruling out other conditions such as diabetic complications (neuropathy) or skin cancer. In some cases, your provider may order an ultrasound or biopsy.

The first line of treatment is usually compression therapy and leg elevation. If the wound is infected, not healing, or large, it may require more advanced treatment including medications, debridement, or surgery.

A Word From Verywell

Many people feel anxious or worried when they get a venous ulcer. While venous ulcers can be uncomfortable, they are highly treatable. Contact your healthcare provider if you have symtpoms since early treatment can prevent venous ulcers from getting worse. In the meantime, you can help take control of your health by making lifesyle changes. This includes eating a healthy diet, exercising, and quitting smoking (if you are a smoker).

Frequently Asked Questions

  • Can venous ulcers cause death?

    Death from a venous ulcer is possible but highly unlikely. It's possible because an untreated infected wound can lead to complications such as sepsis, a severe bloodstream infection.

  • Do leg ulcers lead to amputation?

    Without treatment, venous ulcers can get worse and cause skin and bone infections that put you at risk for amputation. However, with treatment, the chance of needing an amputation from a venous ulcer is highly unlikely.

  • How can you tell the difference between arterial and venous ulcers?

    Arterial ulcers are red, black, or yellow open sores that do not bleed. Venous ulcers typically start as a red or dark area of the skin that gets thick, dry, or itchy. Arterial ulcers are cool to the touch, deeper, and more painful than a venous ulcer.

  • What is the average size of a venous leg ulcer?

    One study showed that half of their participants had sores less than 2 centimeters while the other half had sores larger than 2 centimeters. When sores take longer than three months to heal or are larger than 10 centimeters, a prognosis of complete healing declines.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Library of Medicine (NIH). Venous ulcers - self-care. MedlinePlus.

  2. Bonkemeyer Millan S, Gan R, Townsend PE. Venous ulcers: Diagnosis and treatment. Am Fam Physician. 2019;100(5):298-305.

  3. Jull A, Lu H, Jiang Y. Statins and venous leg ulcer healing: Secondary analysis of data from a cohort of three randomised controlled trials. Wound Repair Regen. 2022;30(2):186-189. doi: 10.1111/wrr.12987

  4. Center for Advanced Cardiac and Vascular Interventions (CACVI). Arterial leg ulcers

  5. Liu X, Zheng G, Ye B, Chen W, Xie H, Zhang T. Factors related to the size of venous leg ulcers: A cross-sectional study. Medicine (Baltimore). 2019;98(5):e14389. doi:10.1097/MD.0000000000014389

Additional Reading

By Brandi Jones, MSN-ED RN-BC
Brandi is a nurse and the owner of Brandi Jones LLC. She specializes in health and wellness writing including blogs, articles, and education.

Originally written by Natalie Kita