Health & Disease Info
All You Wanted to Know About ... Lower Extremity Ulcerations

You are being seen today for ulcers of your lower legs. There are many reasons why people develop ulcers.

Venous leg ulcers are the most common form of leg ulcer, accounting for about 75% of lower extremity ulcers. Venous leg ulcers form as the result of veins that expand due to venous hypertension. Congenital absence or subsequent failure of valves in the vein reduce the ability of the foot and leg muscle pumps to propel venous blood up and out of the leg. Venous ulcers are always associated with edema and ultimately a brown staining around the ankle as blood escapes into the surrounding tissue as red blood cells break down. Venous leg ulcers can be quite large and occur predominantly on the medial malleolus, where venous hypertension is greatest. The ulcers are shallow with irregular edges and the surface of the wound is moist. Compression of the limb and elevation remains the cornerstone of therapy for patients with venous ulcers. Because venous hypertension is a lifelong condition, venous ulcers will recur frequently if the patient does nothing to combat the venous hypertension. Once healing is achieved, patients should be fitted with compression stockings and persuaded to wear their hosiery whenever they are ambulatory.

Diabetic Foot ulcers are, in essence, pressure ulcers which occur on the foot and result from neuropathy and poor local circulation. Neuropathy (loss of sensation) makes the patient unaware of pressure caused by poor-fitting shoes or injury; this pressure, in turn creates the ulcer. These ulcers are usually very small and deep with steep edges and are often surrounded by calluses. The primary prevention is to make certain the patient remains aware of neuropathy and the danger it poses. Accordingly, the diabetic patient should be urged to examine his/her feet daily and to look for pre-ulcerous lesions. Other preventative techniques include the use of special shoes and professional removal of calluses to reduce pressure at the ulcer site. Because diabetic ulcers have a high risk of infection, they should be monitored closely. When infection is suspected or confirmed, appropriate antibiotic therapy should be used.

Arterial ulcers occur primarily on the foot, but can occur anywhere along the lower leg. These ulcers usually are small, have well-defined borders and are dry and sometimes have a dark brown or black coloration to them. The skin around the ulcer and the lower leg is usually thin, shiny and pale. The ulcers can start because of injury or trauma, but a lack of circulation impedes healing. There is usually significant pain in the leg, especially when the leg is elevated. Improved blood flow is necessary for these ulcers to heal.

We are happy to work with you closely in caring for your ulcers. Please remember that these problems have developed over a period of many years, and the effects that have had on your body tissues are not easily reduced, and the time required for full healing to occur may be prolonged. General recommendations for maintenance of good health in patients with venous problems include the following:

• Exercise your legs regularly even when you are lying in bed or traveling.
• Avoid standing or sitting in one position for a long period of time.
• Wear elastic support stockings whenever your legs are dependant for venous ulcerations.
• Raise up on your toes several times and hour.