Venous ulcer is a wound that can develop on the legs, especially around the ankle. It usually does not heal easily and may become deeper over time.

A venous ulcer can cause pain and itching. It may also be linked to leg swelling, skin darkening, and thickened skin. A venous ulcer, also called a varicose ulcer, happens because of changes in blood circulation. It may be related to deep vein thrombosis, aging, or the use of certain medications.

Treatment for a venous ulcer should be guided by a dermatologist or vascular specialist. It usually includes compression stockings to help improve local circulation and wound treatments that support healing.

Main symptoms

The main signs and symptoms of a venous ulcer are:

Wound that does not heal easily;
Wound with irregular, shallow edges, which may become deeper and develop more defined edges over time;
Yellowish fluid coming from the wound;
Pain, itching, and redness in the area;
Swelling around the wound;
Darkening and thickening of the skin;
Flaking in the area.

A venous ulcer usually appears around the ankle. It may also be associated with other symptoms, such as varicose veins and a feeling of heaviness in the legs.

It is important to see a doctor as soon as signs and symptoms that may suggest a venous ulcer appear. This helps treatment begin early, which can help treat the ulcer and prevent infection and tissue death.

Confirming a diagnosis

A venous ulcer should be diagnosed by a vascular specialist, dermatologist, or primary care doctor. The doctor evaluates the ulcer’s characteristics, such as its location, size, depth, edges, presence of fluid, and swelling in the area.

The doctor also checks for skin thickening, skin darkening, and signs of inflammation.

Possible causes

The development of a venous ulcer is usually linked to circulation problems and may be related to:

Deep vein thrombosis;
Aging;
Obesity;
Sedentary lifestyle;
Smoking;
Standing for many hours.

In addition, pregnancy and the use of medications, such as birth control pills, for example, can cause changes in blood circulation and increase the risk of developing an ulcer.

Arterial vs. venous ulcers

The main difference between arterial and venous ulcers is what causes them. Arterial ulcers develop when the arteries do not deliver enough blood and oxygen to the skin. Venous ulcers develop when blood does not flow properly back to the heart and builds up in the legs.

Venous ulcers are more common. Arterial ulcers are often linked to peripheral artery disease (PAD), especially in people who smoke or have diabetes, high blood pressure or high cholesterol.

Because treatment is different for each type, a doctor should identify the cause before treatment begins.

Feature	Arterial ulcer	Venous ulcer
Main cause	Poor blood flow through the arteries, usually from PAD	Poor blood flow through the veins
Usual location	Toes, heels, top of the foot or outer ankle	Lower leg, usually above the inner ankle
Appearance	Deep, round wound with clear edges	Shallow wound with irregular edges
Drainage	Little or none	Moderate to heavy
Pain	Often severe and may get worse when the leg is raised	Usually mild to moderate and may improve when the leg is raised
Skin around the wound	Cool, thin, shiny or pale	Warm, swollen, itchy or brownish
Foot pulse	Weak or absent	Usually present
Other signs	Leg pain when walking that improves with rest	Leg swelling, especially later in the day
Main treatment	Improving blood flow and controlling cardiovascular risk factors	Compression therapy, leg elevation and treatment of damaged veins when needed

To confirm the cause, the doctor may check the ankle-brachial index (ABI), which compares blood pressure in the ankle and arm. A Doppler ultrasound may also be used to check blood flow.

Getting the correct diagnosis is especially important because compression stockings and bandages, which are commonly used for venous ulcers, can make poor arterial blood flow worse. Some people have both arterial and venous disease, called a mixed ulcer, and may need specialized treatment.

A leg or foot wound that does not heal within 2 to 4 weeks should be checked by a doctor. Seek medical care sooner if the wound turns black, becomes very painful or hot, has a bad-smelling discharge, or is accompanied by fever.

Treatment options

Treatment for a venous ulcer should be done with medical guidance. The goal is to prevent new ulcers, relieve pain, prevent infections, improve venous circulation, and help the existing ulcer heal.

1. Wound cleaning

It is important to clean the wound to prevent infections, which can make the ulcer worse and lead to tissue necrosis.

Cleaning should be done with 0.9% saline solution, which does not interfere with the healing process, does not cause allergic skin reactions, and does not change the skin’s normal microbiota.

After cleaning, the doctor may recommend applying a dressing with hydrogel, alginates, or collagenase ointment, depending on the medical indication. These products can help remove dead tissue and support healing.

2. Use of compression stockings

The doctor may also recommend compression stockings to help stimulate local circulation. This can reduce swelling and lower the risk of new wounds, since compression helps support both microcirculation and macrocirculation.

Graduated compression stockings should be prescribed by a vascular specialist. There are several types, so it is also important to identify the factors that may be related to the circulation changes, allowing the doctor to choose treatment based on the cause.

3. Moving the leg

It is also important to move the leg through walking or physical therapy exercises. This helps activate local circulation and reduce blood pooling, helping prevent new ulcers and recurrence.

4. Use of medications

If a bacterial infection is found in the wound, the doctor may prescribe antibiotics based on the microorganism present in the wound.

5. Surgery

For wounds that are difficult to heal, have not healed with compression therapy and dressings, or are very large, surgery may be recommended.

This surgery is done by placing a skin graft over the ulcer area. A piece of tissue is removed from another part of the body and placed where the ulcer is located, helping the wound heal.

Venous Ulcer: Symptoms, Causes & Treatment