Stubborn and slow healing ulcers, commonly referred to as "open legs", can have many causes. Vascular diseases or diabetes can often lead to ulcers developing in the lower leg (Ulcus Curis). Depending on the progression and severity of the condition, very different therapeutic approaches are taken for the open leg. This article describes venous leg ulcers and lower leg ulcers based on chronic venous insufficiency.
What factors can cause an open leg venous ulcer ?
Venous leg ulcers often arise from a connective tissue weakness that leads to so-called bulging of the vein walls (this is often due to genetics). Because of the enlarged veins, the venous valves that are supposed to prevent the blood from flowing back into the legs don’t work properly (venous valve insufficiency). This leads to a backwards pressure and increased pressure on the veins themselves, under which the weakened vein walls give way. The high pressure pushes fluid (including blood, water and other waste in the body) into the tissue, causing water retention (known as oedema). The smallest and thinnest blood vessels, known as capillaries), are particularly sensitive to this increased pressure, and the oxygen and nutrient supply to the tissue suffers as a result. The changed blood circulation also affects the skin: The upper layer of the skin becomes thin and stretched, appearing glassy or shiny, while the skin and subcutaneous tissue can harden (sclerosis). The skin's ability to heal itself is lost, and even small injuries will no longer heal, while in particularly badly affected areas, the upper layers of the skin can perish even without external influence. This leads to ulcer formation , which usually begins in the area of the ankles, as the skin and subcutaneous tissue are particularly thin there. Ulcers in these areas make up about 80% of venous ulcers in general. Only around a fifth of leg ulcers are caused by arterial circulatory disorders, diabetes, rheumatic diseases or infections.
Early warning signs of chronic venous insufficiency
Venous leg ulcers always arise on the basis of a chronic weakness of the connective tissue of the venous walls. This means that long before a lower leg ulcer develops, the chronic venous weakness (chronic venous insufficiency, CVI) becomes noticeable through a range of warning signs. It is divided into three stages:
Stage 1: Temporary swelling of the feet, ankles or lower legs; bluish protruding skin veins on the inner or outer edge of the foot or around the ankles (appearing like varicose veins); Spider veins on lower legs or ankles.
Stage 2: Persistent swelling and oedema in the legs, ankles or feet; brownish or bluish colour of the skin.
Stage 3: Open ulcers in affected area.
Spider veins or varicose veins can also be early warning signs of chronic venous insufficiency and a vein thrombosis or post-thrombotic syndrome are often part of the history of venous leg ulcers.
Typical symptoms of CVI are also
- Feeling of heaviness and tension or pain in the legs.
- Leg cramps, especially at night while resting.
- Burning, tingling, itching in the legs.
- Feeling overheated in the affected leg, both in sense and to touch.
What causes the development of an open leg?
Venous ulcers always have a history of issues leading up to them. Before an ulcer develops, the underlying venous disease must be well advanced. Possible risk factors include:
- Genetics (family cases of varicose veins, thromboses or lower leg ulcers)
- Sedentary lifestyle
- Older age
- Long periods of standing or sitting at work.
- Smoking and excessive alcohol consumption.
- Taking hormone preparations, especially hormonal contraceptives like the pill.
Venous problems should not be taken lightly. Ignoring them can lead to serious long-term damage up to and including amputation.
How can medical compression stockings help with open legs?
In cases of venous leg ulcers, compression therapy, professional wound care and exercise therapy are among the most important pillars of treatment. Movement (walking long distances consistently) promotes the return flow of venous blood to the heart and has a decongestant effect.
In addition, compression stockings such as the VenoTrain ulcertec have been specially developed for the treatment of lower leg ulcers. To make it more comfortable and easier for day to day wear, the VenoTrain ulcertec is visually indistinguishable from a normal stocking.
Unlike compression bandages, it does not slip and thus provides long-lasting, even-spread pressure on the affected leg - even when moving. The patented knitted fabric also makes it easy to put on and take off and ensures high wearing comfort all day. The VenoTrain ulcertec consists of a two part construction, with an inner lining for wound management, and an outer lining for primary compression, and is available in two different compression strengths in order to ensure optimal treatment, above all appropriate to the severity of the disease.
For assistance selecting the right product for your needs, book a video consultation with a Bauerfeind expert: Call us on +971 4 433 5684.