Leg Ulcers: What Is It, Treatments, Causes and Types

Leg ulcers are chronic wounds that occur due to impaired blood circulation, often linked to venous insufficiency or arterial disease. They present with persistent pain, non-healing wounds, and risk of infection if left untreated.

Venous leg ulcers are the most common type, typically developing around the ankle area due to valve dysfunction in leg veins. Poor circulation causes fluid buildup, skin changes, and eventual ulcer formation.

Arterial ulcers result from insufficient blood flow caused by peripheral artery disease. They are usually painful, with sharply defined edges, and carry a higher risk of severe tissue damage or amputation if untreated.

Treatment of leg ulcers includes compression therapy, wound care, infection control, and in some cases surgical intervention. Addressing the underlying vascular condition is essential for complete healing and prevention of recurrence.

Medical Name	Leg Ulcer (Venous Ulcer, Arterial Ulcer, Diabetic/Neuropathic Ulcer)
Common Symptoms	– Open wound on the leg that does not heal- Pain or tenderness- Redness, soreness around the wound- Wound with foul odor or discharge
Causes	– Venous insufficiency (venous insufficiency) – Arterial insufficiency (arterial congestion) – Diabetes and peripheral neuropathy – Trauma
Risk Factors	– Circulatory disorders- Diabetes- Obesity- Long-term inactivity- Old age- Smoking
Complications	– Infection – Deepening or widening of the wound – Chronic pain – Rarely tissue death (gangrene)
Diagnostic Methods	– Physical examination- Doppler ultrasonography- Blood tests- Wound culture (if infection is suspected)
Treatment Methods	– Wound care and dressing – Treatment of the underlying disease – Compression therapy (for venous ulcer) – Antibiotics or surgical intervention if necessary
Prevention Methods	– Regular leg care – Circulation-enhancing exercises – Blood sugar and blood pressure control – Weight control and smoking cessation

What is this Intractable Sore Called Leg Ulcer?

You can think of a leg ulcer as an open sore that extends into the lower layers of the skin and takes up to two weeks to heal. It usually occurs between the knee and ankle, often on the inner side of the leg. The main feature that distinguishes this condition from a simple scrape is that there is a deep tissue loss that affects multiple layers of the skin, not just the surface.

In fact, leg ulcers are a “symptom”, not the disease itself. Just like a warning light that comes on when there is an engine failure, leg ulcers are a sign that something is wrong with your body’s circulatory system. It should not be seen as a superficial skin problem, as it is almost always caused by an underlying medical condition that affects the blood circulation. These wounds are particularly common in older people and, if left untreated, can seriously impair quality of life and lead to serious health problems.

What is the Difference Between an Ordinary Cut and Symptoms of Leg Ulcer?

In the case of an ordinary cut or scratch, our body’s wonderful repair mechanism kicks in and the wound usually closes on its own within a few weeks. But leg ulcer is a condition where this natural healing process does not work. And why? Because the source of the problem is not the wound itself, but a deeper problem that prevents the wound from healing.

We can liken this problem to the construction of a road. A small crack in the road (an ordinary wound) can be easily repaired. But if the foundation (circulatory system) underneath the road is broken, deep potholes (ulcers) will constantly open up on the surface. No matter how much you fill this hole, the wound will open again unless the underlying problem is solved. This “bad foundation” behind leg ulcers is usually poor blood flow in the veins (venous insufficiency) or arteries (arterial disease). Insufficient blood flow means that damaged tissue cannot get the oxygen and nutrients it needs to repair itself. This is why leg ulcers do not heal on their own and require specialized medical treatment, both for the wound itself and for the underlying circulatory problem.

When is a wound called a ‘chronic ulcer’?

Medically, a wound is considered to be chronic at the point at which it deviates from the normal healing process. According to general belief, if a wound does not show significant improvement within two to four weeks despite proper care, it is now classified as a “chronic ulcer”. If a sore has been with you for more than three months, it is definitely considered a chronic case. Acute wounds after trauma or surgery are expected to heal within four weeks. Chronic ulcers, on the other hand, cannot enter this normal healing process due to complex underlying causes.

What are the Symptoms of General Leg Ulcer and What Should I Pay Attention to?

Although the symptoms of leg ulcers vary depending on the underlying cause, some common features may attract the attention of patients. These symptoms are important signals your body is sending you. The general symptoms of leg ulcers are as follows:

• Open wound that has not healed for more than two weeks
• Fluid leaking from the wound (discharge or pus)
• Pain, aching or a feeling of heaviness in the affected leg
• Itching in the leg
• Heat in the ankle or leg (edema)
• Discoloration of the skin around the wound (brown, purple, red spots)
• Hardening, shining or dryness of the skin around the wound
• Bad smell from the Creator
• If you are experiencing one or more of these symptoms, it is best not to underestimate the situation and consult a specialist.

What are the Main Types of Leg Ulcers and What Causes Ulcers?

Since more than a third of leg ulcers are caused by vascular diseases, the first step in proper treatment is to correctly identify the source of the problem, i.e. the type of ulcer. This allows us to find the answer to the question “why do ulcers occur?”. There are three main types:

Venous ulcers: The most common type, accounting for the vast majority (`-90%) of all cases. It is caused by a problem with blood flow in the veins.

Arterial ulcers: The second most common type (5-20%). It occurs because of poor blood circulation in the arteries.

Diabetic (Neuropathic) Ulcers: It occurs in diabetic patients and is caused by a combination of nerve damage and poor blood circulation.

Sometimes patients may have both venous and arterial problems. This condition is called “ulcer of mixed etiology” and requires a more complex approach to treatment.

What Causes the Most Common Venous Leg Ulcer?

A venous ulcer is caused by a “drainage” problem in the veins of the legs. You can think of the veins as pipes that carry dirty blood from the legs to the heart. Inside these tubes are one-way valves that prevent the blood from backing up by gravity. In the case of Chronic Venous Insufficiency (CVI), these valves fail.

Because of faulty valves, blood cannot return to the heart efficiently and begins to pool in the legs, especially around the ankle. This leads to a constant high pressure inside the veins (venous hypertension). Over time, this high pressure damages the smallest blood vessels (capillaries), causing the skin to become thinner, more sensitive and discolored. Skin that has become so fragile is easily torn by the slightest bump or scratch. Because of the underlying high pressure, the wound cannot heal and the vein turns into a tumor.

What Are the Causes Behind Painful Arterial Ulcer?

Arterial ulcer is a “nutritional” problem. Imagine arteries as pipes of clean water that carry oxygen and nutrients to the tissues. In the case of Peripheral Arterial Disease (PAD), these pipes narrow or clog over time due to arteriosclerosis (atherosclerosis). Smoking, high cholesterol, high blood pressure and diabetes are largely responsible for this clogging.

The narrowed arteries cannot carry enough oxygen and nutrients to the tissues of the legs and feet. This reduction in blood flow is called “ischemia”. Without oxygen, the tissues wither, become damaged and eventually die (necrosis), just like a dehydrated flower. Even the smallest cut or bruise in an area where blood flow is critically reduced cannot heal and quickly turns into a deep, painful arterial ulcer. These ulcers usually occur in areas such as the toes or heels, which are furthest from the heart and have the poorest blood flow.

Why is foot ulcer in diabetic patients so important?

Diabetic foot ulcer is a dangerous combination of two major problems caused by diabetes: nerve damage (neuropathy) and poor blood circulation. The mechanism of formation of these ulcers is quite complex.

High blood sugar damages nerves over time. In particular, “sensory neuropathy” causes patients to lose the feeling of pain, temperature or pressure in their feet. It’s like when the warning lights in your car go out; you don’t even know there’s a problem. The patient may not notice a nail sticking into their foot, a blister from a wet shoe, or a small cut. In addition, arteriosclerosis, which is accelerated by diabetes, impairs blood flow and prevents wounds from healing. As a result, an unrecognized injury cannot heal due to poor blood flow and can easily become infected with serious consequences, up to the loss of a limb. Therefore, foot care for diabetic patients is of vital importance.

What Symptoms Does Venous Ulcer Present Itself?

There are quite typical symptoms that distinguish venous ulcers from others. Knowing these symptoms gives important clues for a correct diagnosis. The characteristic features of a venous ulcer are the following:

Location: Usually on the inside of the flue, just above the ankle bone (“gaiter area”).

Appearance: It is usually a large, wet wound with irregular edges.

Wound Mattress: It is usually red in color and covered with a yellowish layer of fibrin:

Runoff: It has a “wet” appearance due to moderate to abundant runoff.

Pain: There is usually a dull, aching pain. The most typical feature is pain relief by raising (elevating) the chimney.

Circumferential Skin: The leg is often marked by edema, brownish spots, hardened and leathery skin and varicose veins.

What are the Distinguishing Features and Symptoms of Arterial Ulcer?

Arterial ulcers are quite different from venous ulcers in that they are the result of insufficient blood flow. The diagnostic features of arterial ulcer are as follows:

Location: Usually above bony prominences such as the tips of the toes, heels or the outside of the ankle.

Appearance: A deep wound with sharp, jagged edges that looks like it has been “pierced with a stapler”.

Wound Bedding: It may be pale, gray, or black (necrotic) because there is no blood flow.

Fluid: There is usually little or no discharge, so it has a “dry” appearance:

Pain: Very severe, sharp and burning pain is present. The pain increases, especially at night or when the leg is raised, and is temporarily relieved by lowering the leg out of bed.

Environmental Skin: Usually cold, pale or bruised to the touch. The skin is shiny, taut and the hair in that area has fallen out.

What Symptoms Differentiate Diabetic Foot Ulcer from Others?

Diabetic foot ulcers have unique and dangerous characteristics, often accompanied by nerve damage. Typical findings of these ulcers are as follows:

Location: Most commonly on the sole of the foot, heel or areas subject to pressure such as the toes.

Appearance: It is usually surrounded by a thick callus layer. This is one of its most distinctive features.

Pain: It is usually painless due to nerve damage (neuropathy). This lack of pain delays recognition of the wound and increases the risk of infection.

Signs of Infection: Signs of infection such as redness, soreness, heat, increased temperature and foul-smelling discharge are common and require urgent intervention.

Which department should be consulted for the diagnosis of leg ulcer and what is done in the first examination?

When you notice a wound on your leg that is not healing, the right place to turn is to a Cardiovascular Surgeon. Because it is he or she who can best assess and treat the root of the problem, the vascular system. During the initial examination, the diagnostic process proceeds like a detective. The doctor first asks detailed questions to find out when your symptoms started, your risk factors such as diabetes or smoking, and your general health history. He or she will then carefully examine both of your legs. In addition to the location, size and depth of the wound, the doctor will look for clues such as discoloration, discoloration and temperature difference in the legs. Palpation of the pulses in the feet for initial assessment of arterial blood flow is an important part of this first step.

How Does Doppler Ultrasound Detect Vascular Problems?

Doppler ultrasound is one of the most basic and valuable tools used to diagnose leg ulcers. You can think of this test as a “road camera” that shows the blood flow inside your veins. Thanks to this painless and harmless test using sound waves, we can clearly see inside the vessels.

For venous ulcers: With the Venous Doppler, we determine whether the valves in the veins are malfunctioning (venous reflux) and whether the blood is backing up. This test also tells us if there is a clot in the vein (DVT).

For arterial ulcers: Arterial Doppler allows us to determine the location and severity of narrowing or congestion in the arteries. This gives a clear indication of how much the blood flow has decreased.

Why is Ankle-Arm Pressure Index (ABI) Testing So Critical for Treatment?

The ABI (Ankle-Brachial Index) test is a simple but vital test. With this test, using a blood pressure monitor and a Doppler device, we compare the blood pressure in the foot to the blood pressure in the arm. This is the most reliable and simple method to show whether your legs are getting enough blood. The ABI test plays a critical role in the safety of treatment, especially for patients with venous ulcers. The main treatment for venous ulcers is compression (pressure bandage) therapy. However, if the patient also has severe arterial disease (low ABI), applying high pressure to the leg can further reduce blood flow, leading to tissue damage and very dangerous consequences. The ABI test eliminates this risk and allows us to formulate a safe treatment plan.

How to recognize bone infection (osteomyelitis) in diabetic foot ulcer?

One of the greatest dangers of diabetic foot ulcers is the spread of infection to the bone (osteomyelitis). Diagnosing this early is vital to prevent limb loss. We use several methods for diagnosis. in a simple office test called “probe-to-bone”, if the base of the wound feels hard bone tissue when touched with a sterile instrument, the suspicion of osteomyelitis is very high. Elevated levels of certain inflammatory markers (ESR, CRP) in blood tests are also an important clue. However, imaging methods are used for the most definitive diagnosis. Although X-rays are taken first, MRI (Magnetic Resonance Imaging) is the method that shows the infection in the bone earliest and most clearly.

What is the Right Wound Care for All Types of Ulcers?

Wound care alone cannot permanently cure ulcers until the underlying vascular problem is resolved. However, proper wound care is an indispensable part of treatment to prepare the healing environment and prevent infection. This process consists of three basic steps: cleaning the wound, removing dead tissue (debridement) and closing with appropriate dressing material. Cleaning is usually done gently with saline. Debridement is the removal of dead tissue in the wound bed that interferes with healing by a health professional. This encourages healthy tissues to grow. Finally, modern dressing materials, selected according to the condition of the wound, keep the wound bed moist, which speeds healing.

How to Treat Venous Leg Ulcer?

The aim of venous ulcer treatment is to eliminate the high pressure (venous hypertension) caused by the accumulation of blood in the leg. Two main treatment methods are used for this.

Compression Therapy: This is the cornerstone of treatment. With special multi-layered bandages or varicose vein stockings made with customized measurements, a controlled pressure is applied to the leg. This pressure prevents blood from stagnating in the vessels, reduces pain and promotes the return of blood to the heart, allowing the wound to close.

Treatment of Underlying Vascular Insufficiency: It is not enough just to close the wound, it is necessary to dry the source of the problem. For this, minimally invasive methods such as endovenous thermal ablation (laser or radiofrequency) or sclerotherapy (foam therapy) are used to close the affected vein. With these modern methods, the problem vessel is closed from the inside and the blood flow is redirected to healthy vessels. This procedure both cures the existing ulcer and prevents new ulcers from developing in the future.

What is the goal and what methods are used in the treatment of arterial ulcer?

Treatment of arterial ulcers has one clear goal: to open the blocked artery and restore blood supply to the leg (revascularization). It is impossible to heal the wound without restoring the supply to the leg. Interventional treatments for this include the following:

Angioplasty and stenting: Just like in the heart, a small needle is inserted through the groin to access the obstructed leg vein. This vessel is widened with a balloon (angioplasty) and a metal cage (stent) is usually inserted to prevent it from narrowing again.

Bypass Surgery: If the blockage is too long or not suitable for angioplasty, a “bypass” is performed using a vein from another part of the body or an artificial vein to extend the blood flow beyond the blockage.

What to Focus on in the Treatment of Diabetic Foot Ulcer?

Diabetic foot ulcer treatment is a comprehensive approach that requires fighting on multiple fronts. The pillars of treatment are as follows:

Off-loading (Pressure Reduction): Eliminating the pressure on the area is the most important step to allow the wound to heal. For this, special casts (Total Contact Cast), special shoes or orthotics are used.

Infection Control: If infection is present, it should be treated aggressively with the right antibiotics, with deep tissue culture removed.

Blood Sugar Control: Keeping blood sugar levels tightly controlled increases the body’s capacity to fight infection and heal the wound.

Revascularization: If the patient also has arterial congestion (neuroischemic ulcer), interventions such as angioplasty or bypass to increase blood flow should be performed.

How Do Skin Grafts Developed for Wounds That Do Not Heal Work?

For persistent chronic wounds that do not respond to standard treatments, it is sometimes necessary to resort to more advanced technologies. This is where bioengineered skin substitutes or skin grafts come into play. These products are special covers developed in the laboratory that mimic the structure of the skin. When placed over the wound, they act as a “scaffold” into which the body’s own cells can grow. They also accelerate wound closure by secreting growth factors that stimulate the healing process. They have been proven to increase wound closure rates, especially in diabetic and venous ulcers.

How does Hyperbaric Oxygen Therapy (HBOT) contribute to the healing process?

Hyperbaric Oxygen Therapy (HBOT) is a powerful adjunctive treatment method used especially for conditions such as hard-to-heal diabetic foot ulcers. In this treatment, the patient breathes 0 pure oxygen in a special room with the pressure increased to 2-3 times the normal atmospheric pressure. This increases the amount of oxygen carried by the blood many times above normal. When this oxygen-rich blood reaches the tissues, it supports the healing process in many ways. It promotes the formation of new blood vessels (angiogenesis), increases the body’s ability to fight infection and triggers the release of growth factors.

What can be done to prevent recurrence of venous ulcers?

Venous ulcers tend to recur even after healing, unless the underlying venous insufficiency is controlled. To prevent this, there are some important lifelong considerations:

• Wearing preset compression stockings regularly
• Raising legs above heart level several times a day
• Doing exercises such as regular walking
• Getting rid of excess weight
• Avoid standing or sitting still for long periods of time
• Maintain skin integrity by keeping it clean and moisturized

How to Maintain Arterial Health to Reduce the Risk of Arterial Ulcer

Preventing arterial ulcers and underlying Peripheral Arterial Disease requires adopting a lifestyle geared towards maintaining vascular health. The most important steps that can be taken are the following:

• Quitting smoking completely (the most important step)
• Implement a regular walking program
• Eating a diet low in saturated fat and cholesterol
• Keeping diabetes under control
• Managing high blood pressure
• Lowering high cholesterol with medication and diet
• Protecting feet from minor injuries

What is the Daily Foot Care Routine for Diabetes Patients?

For diabetics, daily foot care is not a luxury but a vital necessity to prevent limb loss. This simple but effective daily routine can greatly prevent ulcer formation:

• Check your feet every day (especially the soles and between the toes) with a mirror.
• Look for cuts, blisters, redness, stains or discoloration.
• Wash your feet daily with warm water and mild soap.
• After washing, dry your feet gently and completely, including between the toes.
• Apply moisturizing lotion to prevent the skin from drying out and cracking (except between the toes).
• Cut the nails straight so as not to cause ingrown nails and gently trim the cuticles.
• Never walk barefoot.
• Wear protective and comfortable shoes that fit your feet well.
• Before putting on your shoes, check them with your hand for foreign objects inside.

What are the Dangerous Signs of Infection in Leg Ulcer?

A leg ulcer, which is an open wound, is always at risk of infection. Infection is a dangerous condition that makes treatment difficult and can lead to serious complications. If you notice any of the following warning signs, you should contact your doctor immediately:

• Sudden and severe increase in pain around the wound
• The discharge from the wound turns green in color or has a faint odor
• Increased redness, heat and soreness of the skin around the wound
• 37.fever or chills exceeding 8°C
• Feeling sick and weak in general

In Which Situations Should You Go to the Emergency Room Immediately?

Some situations may indicate a serious problem that requires an emergency room visit. In the following situations, you should go to the nearest emergency room immediately:

• If the wound is deep and bone or tendon is visible underneath
• If you cannot step or walk on your affected chimney
• If you have the above-mentioned symptoms of infection with fever
• If the leg suddenly becomes suddenly warm, pale or noticeably cooler than the other leg (This may be a sign of an acute arterial blockage that completely cuts off the blood supply to the leg and requires urgent attention)
• If you have diabetes, any new sore on your foot needs to be seen by a professional immediately.

Why Should You See a Cardiovascular Surgeon for Leg Ulcer?

Let’s summarize why treating leg ulcers is a team effort, but why the leader of this team should be a Cardiovascular Surgeon. Although wound care nurses, podologists and dermatologists make valuable contributions to this process, it is the vascular surgeon who has the ability to get to the root of the problem and offer a permanent solution.

The reason for this is simple: The root cause of more than a third of leg ulcers is a defect in the vascular system. A cardiovascular surgeon is a specialist who uses special diagnostic methods, such as Doppler ultrasound and ABI testing, to determine precisely whether the ulcer is venous, arterial or mixed. Simply dressing a wound is like painting the walls of a building with a rotten foundation; it looks good for a while, but the building eventually collapses. Lasting improvement requires resolution of the underlying vascular problem.

For venous ulcers: Vascular surgeons use precise treatment methods such as endovenous ablation and sclerotherapy to eliminate the source of the problem, venous reflux.

For Arterial Ulcers: He is the only specialist vascular surgeon who performs revascularization procedures such as angioplasty, stenting and bypass surgery to restore vital blood flow to the leg.

The Cardiovascular Surgeon manages the entire process, from initial diagnosis to treatment, from long-term follow-up to prevention strategies. This is a holistic approach that improves your overall vascular health, not just your wound. Therefore, the right door to turn to for the unhealing wound on your chimney is the door of a Cardiovascular Surgery specialist who can solve the root of the problem and make permanent improvement possible.