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 Unraveling the Mystery: What Is the Main Cause of Leg Ulcers?

Last Updated on May 20, 2023 by Nurse Vicky

 Unraveling the Mystery: What Is the Main Cause of Leg Ulcers?

Leg ulcers are a common and often distressing condition that affects millions of people worldwide. These open sores on the lower leg can be painful, slow to heal, and significantly impact a person’s quality of life. Understanding the main cause of leg ulcers is crucial for effective treatment and prevention.

In this comprehensive article, we will delve into the intricacies of leg ulcers, explore their primary causes, and provide valuable insights to help you better manage this condition. So, let’s unravel the mystery and gain a deeper understanding of what lies behind leg ulcers.

 What are Leg Ulcers?


Leg ulcers are open sores or wounds that develop on the lower leg, typically below the knee and above the ankle. These ulcers can be shallow or deep and may take a long time to heal. They often result from underlying medical conditions and are associated with impaired blood circulation, especially in the veins and arteries of the legs.

 Understanding the Circulatory System and Its Role


To comprehend the causes of leg ulcers, it’s essential to have a basic understanding of the circulatory system. The circulatory system comprises the heart, blood vessels, and blood. It plays a vital role in supplying oxygen and nutrients to the body’s tissues and removing waste products. Proper blood flow is crucial for tissue health and healing.

 Venous Insufficiency: A Leading Cause of Leg Ulcers


One of the primary causes of leg ulcers is venous insufficiency. This condition occurs when the valves in the veins of the legs become damaged or weakened, leading to poor blood circulation and the accumulation of blood in the lower extremities. Over time, this increased One of the primary causes of leg ulcers is venous insufficiency.

This condition occurs when the valves in the veins of the legs become damaged or weakened, leading to poor blood circulation and the accumulation of blood in the lower extremities. Over time, this increased pressure in the veins can result in the development of ulcers.

Risk Factors for Venous Insufficiency


Several factors contribute to the development of venous insufficiency and, consequently, leg ulcers.

These risk factors include:

  • Age: As we age, the veins lose their elasticity, making them more prone to valve damage and blood pooling.
  • Obesity: Excessive weight puts increased pressure on the veins, impairing their ability to function properly.
  • Pregnancy: Hormonal changes and the pressure of the growing uterus on the veins can lead to venous insufficiency.
  • Family History: A genetic predisposition to weak vein valves can increase the likelihood of developing venous insufficiency.
  • Sedentary Lifestyle: Lack of physical activity can hinder blood circulation and contribute to venous insufficiency.
  • Previous Blood Clots: A history of deep vein thrombosis (DVT) or other blood clotting disorders can damage the veins, leading to insufficiency.

 Symptoms of Venous Insufficiency


Recognizing the signs of venous insufficiency is crucial for early intervention.

Common symptoms include:

  • Swelling in the lower legs, ankles, and feet
  • Aching or throbbing pain in the legs, especially after prolonged standing or sitting
  • Varicose veins, which are swollen and twisted veins visible beneath the skin
  • Itching or a feeling of heaviness in the legs
  • Skin discoloration, such as redness or brownish pigmentation
  • Slow-healing wounds or ulcers on the lower leg, particularly around the ankle area

Arterial Insufficiency: Another Significant Cause of Leg Ulcers


While venous insufficiency is a common cause of leg ulcers, arterial insufficiency can also contribute to their development. Arterial insufficiency occurs when there is inadequate blood flow through the arteries, depriving the tissues of necessary oxygen and nutrients. Without a proper blood supply, the skin and underlying tissues become vulnerable to injury and slow wound healing.

 Risk Factors for Arterial Insufficiency


Several factors increase the risk of arterial insufficiency and subsequent leg ulcers:

  • Smoking: Smoking damages the arteries, leading to narrowed blood vessels and reduced blood flow.
  • Diabetes: Uncontrolled diabetes can damage blood vessels, increasing the risk of arterial insufficiency.
  • High Blood Pressure: Hypertension can cause arterial damage and impair blood flow.
  • High Cholesterol: Elevated cholesterol levels can contribute to the formation of plaque in the arteries, restricting blood flow.
  • Peripheral Artery Disease: Atherosclerosis, a condition characterized by the buildup of fatty deposits in the arteries, can lead to arterial insufficiency.

Symptoms of Arterial Insufficiency


Arterial insufficiency often manifests with distinct symptoms, including:

  • Leg pain, especially during physical activity and relieved by rest
  • Cold feet or legs
  • Pale or bluish skin discoloration
  • Weak or absent pulses in the feet and legs
  • Slow-healing or non-healing wounds or ulcers on the lower leg or foot
  • Hair loss or thinning on the legs and feet

 Diabetes and Leg Ulcers


Diabetes is a chronic condition that can significantly contribute to the development of leg ulcers. Individuals with diabetes are at a higher risk of developing ulcer

Diabetes is a chronic condition that can significantly contribute to the development of leg ulcers. Individuals with diabetes are at a higher risk of developing ulcers due to various factors, including impaired blood circulation, nerve damage (neuropathy), and compromised immune function.

How Diabetes Contributes to Leg Ulcers


In diabetes, high blood sugar levels can lead to damage to the blood vessels, particularly the smaller ones supplying the legs and feet. This vascular damage, combined with neuropathy, reduces blood flow and impairs sensation in the extremities.

As a result, minor injuries such as cuts, blisters, or sores may go unnoticed and fail to heal properly. Over time, these non-healing wounds can progress into ulcers.

Additionally, diabetes weakens the immune system, making it more difficult for the body to fight off infections. When an ulcer forms, it becomes susceptible to bacterial growth and increases the risk of complications such as cellulitis or even deep tissue infections.

Preventing and Managing Diabetic Leg Ulcers


Prevention and proper management are crucial in reducing the incidence of leg ulcers in individuals with diabetes.

Some key strategies include:

  • Maintaining good blood sugar control: Keeping blood glucose levels within the target range helps promote better wound healing and reduces the risk of complications.
  • Regular foot care: Inspecting the feet daily, washing them with lukewarm water, and keeping the skin moisturized can help prevent skin breakdown and identify any abnormalities or wounds at an early stage.
  • Wearing appropriate footwear: Choosing comfortable shoes that fit well and provide adequate support can help prevent pressure points and reduce the risk of developing ulcers.
  • Regular check-ups: Routine visits to healthcare professionals allow for early detection of any foot or leg issues, allowing for prompt intervention and prevention of ulcers.

Infections and Wound Healing


Infections play a significant role in the progression and delayed healing of leg ulcers. When an ulcer occurs, it creates an entry point for bacteria, leading to infection. Furthermore, the presence of infection can impair the natural wound-healing process.

Infection as a Cause of Leg Ulcers


Leg ulcers can become infected through various means, including exposure to bacteria in the environment or from the individual’s own skin flora. Poor wound care, inadequate hygiene, and underlying conditions such as diabetes or compromised immune function can increase the likelihood of infection.

The Importance of Proper Wound Care

Proper wound care is essential for preventing and managing leg ulcers.

The following measures are crucial:

  • Cleaning the wound: Gently washing the ulcer with mild soap and water or a saline solution helps remove debris and reduce the risk of infection.
  • Applying appropriate dressings: Dressings protect the wound, facilitate a moist environment conducive to healing, and may contain antimicrobial properties to prevent or treat the infection.
  • Managing exudate: Leg ulcers may produce varying amounts of fluid, and appropriate dressings should be chosen to absorb excess exudate while maintaining a moist wound environment.
  • Debridement: In some cases, debridement may be necessary to remove dead or non-viable tissue from the wound bed, promoting the growth of healthy tissue.
  • Antibiotics: If an infection is present, healthcare professionals may prescribe antibiotics to target the specific bacteria causing the infection.

Other Contributing Factors


In addition to venous insufficiency, arterial insufficiency, and diabetes, several other factors can contribute to the development of leg ulcers. These include obesity, peripheral vascular disease (PVD), and smoking.

 Obesity and its Impact on Leg Ulcers

Obesity places increased pressure on the veins and arteries, hindering proper blood flow and increasing the risk of developing leg ulcers. The excess weight puts strain on the vascular system, leading to weakened vein valves, impaired circulation, and potential tissue damage.
Additionally, obesity is often associated with other risk factors such as diabetes and hypertension, further exacerbating the likelihood of leg ulcers.


Peripheral Vascular Disease and Leg Ulcers


Peripheral vascular disease (PVD) refers to the narrowing or blockage of blood vessels outside of the heart and brain. This condition can significantly impact blood flow to the legs, increasing the risk of ulcers.

PVD is often caused by atherosclerosis, where plaque buildup narrows the arteries and restricts blood flow. Reduced blood supply to the legs can result in tissue damage and non-healing wounds, which may progress to leg ulcers.

Smoking and Leg Ulcers


Smoking is a detrimental habit that can have severe implications for vascular health. The chemicals in tobacco smoke damage blood vessels, making them more susceptible to narrowing, blood clot formation, and decreased blood flow.

Smoking also impairs wound healing and weakens the immune system, making smokers more prone to infections. Consequently, smoking significantly increases the risk of developing leg ulcers and hampers the healing process.

Diagnosing Leg Ulcers


Diagnosing the underlying cause of leg ulcers is crucial for effective treatment and management. Healthcare professionals employ various methods to assess and diagnose leg ulcers:

 Clinical Evaluation


During a clinical evaluation, a healthcare provider will examine the ulcer and assess its characteristics, such as size, location, and appearance. They will also consider the patient’s medical history, risk factors, and symptoms to determine the likely cause of the ulcer.

Imaging and Laboratory Tests


In some cases, additional tests may be necessary to support the diagnosis. Doppler ultrasound, for instance, can assess blood flow in the legs and identify any vascular abnormalities. Laboratory tests, including blood tests, can help detect underlying conditions such as diabetes or infection.

Treating Leg Ulcers


The treatment of leg ulcers focuses on addressing the underlying cause, promoting wound healing, and preventing complications. The following approaches are commonly employed:

Compression Therapy


Compression therapy is a cornerstone in managing venous leg ulcers. It involves applying specially designed stockings or bandages to exert external pressure on the veins, promoting blood flow and reducing swelling. Compression therapy helps improve circulation, aids in wound healing, and prevents ulcer recurrence.

Wound Care and Dressings


Proper wound care is essential for promoting healing and preventing infection. Healthcare professionals may recommend various types of dressings, such as hydrogels, foam dressings, or alginate dressings, depending on the characteristics of the ulcer. Regular cleaning, debridement of dead tissue, and appropriate dressings are crucial for maintaining a clean and optimal wound-healing environment.

 Surgical Interventions


In certain cases, surgical interventions may be necessary to address underlying vascular issues or remove non-healing tissue. Procedures such as vein ligation, vein stripping, or angioplasty may be performed to improve blood flow and facilitate wound healing.

Adjunctive Therapies


Additional therapies may be used in conjunction with conventional treatments to enhance healing and manage leg ulcers. These may include growth factors, skin substitutes, negative pressure wound therapy, or hyperbaric oxygen therapy, depending on the individual case and the recommendation of the healthcare provider

Preventing Leg Ulcers


Prevention is key when it comes to leg ulcers, especially for individuals at risk. Here are some important preventive measures to consider:

 Maintaining a Healthy Lifestyle


  • Engage in regular exercise: Physical activity promotes good circulation and helps maintain a healthy weight, reducing the risk of leg ulcers.
  • Follow a balanced diet: A nutritious diet rich in fruits, vegetables, whole grains, and lean proteins supports overall vascular health and can lower the risk of developing ulcers.
  • Manage chronic conditions: Properly managing conditions such as diabetes, hypertension, and high cholesterol can help minimize their impact on vascular health.

Foot and Leg Care


  • Inspect feet daily: Regularly examine the feet for any cuts, sores, or abnormalities. Seek prompt medical attention for any concerning findings.
  • Practice proper hygiene: Keep the feet clean and dry to prevent infections. Use mild soap and warm water, and thoroughly dry the feet, especially between the toes.
  • Moisturize the skin: Regularly apply moisturizer to prevent dryness and cracking, which can increase the risk of ulcers.
  • Trim toenails carefully: Cut toenails straight across and avoid cutting them too short to prevent ingrown toenails and potential skin injuries.
  • Wear comfortable shoes: Opt for well-fitting shoes made of breathable materials to avoid pressure points and promote good circulation. Avoid high heels and tight-fitting footwear.

There are many causes of leg ulcers, but they all have the same basic underlying cause: the underlying condition that causes vascular problems.

Fortunately, arterial ulcers are rare and much easier to treat than other types of ulcers. Vascular (arterial) surgeons can help with this condition. Other causes of leg ulcers include chronic venous insufficiency and varicose veins.

Varicose veins


There are several treatments to help reduce leg ulcers caused by varicose veins. Elevating the legs can help, as can taking medication such as anti-coagulants and diuretics. Other treatments include anti-inflammatory medications that thin blood. Laser surgery is another treatment that uses strong surges of light to close the vein.

However, these treatments do not address the underlying cause of varicose veins. Treatment for leg ulcers typically targets the vein responsible for the ulcer. Physicians will determine which treatment is best for each individual patient.

This may involve ablation,microphlebectomy, or sclerotherapy. The goal is to redirect the blood flow from the ulcer-causing vein to a healthier one. Increased blood flow to the leg will result in improved oxygen and nutrients to the ulcerative area, and eventually, lead to healing.

Chronic venous insufficiency


The best treatment for chronic venous insufficiency is elevating the leg above heart level. This helps reduce swelling and improves blood flow in the leg veins, speeding up the healing process.

It is the most effective treatment, but a footstool does little to improve the drainage of blood from the leg. Leg elevation may be the only treatment needed in mild cases of chronic venous insufficiency.

More severe cases may require surgical management. Treatment for chronic venous insufficiency depends on the symptoms and severity of the disease. Compression stockings and elevating the leg may help. Some people may also benefit from good skin care and exercise.

However, treatment for chronic venous insufficiency is not without risks. The condition may reoccur in the future. But there are ways to improve symptoms and improve the quality of life for those with venous insufficiency.

Arterial ulcers


The main cause of a leg or foot ulcer is blocked blood flow. This causes blood to pool in the affected area and leaks blood cells and fluid. The tissue dies and an ulcer forms. This condition may require amputation in severe cases.

Proper care and antibiotics can help to heal an ulcer, but treating the underlying cause is always recommended. Here are the symptoms and causes of arterial leg ulcers. The main treatment for an arterial leg ulcer involves increasing the blood supply to the affected area.

Compression therapy, which involves applying a bandage to the affected area, helps improve blood flow. Painkillers are also prescribed. Elevating the affected leg will help to reduce the discomfort caused by an ulcer.

Surgery may also be necessary if the ulcer becomes too septic or infected. Treatment for leg ulcers can range from medication to surgery, depending on the severity of the condition.

Compression bandages


Leg ulcers are often caused by underlying conditions. While there is no cure for leg ulcers, there are several ways to treat them, including using compression bandages.

Compression bandages are made of elastic stretch fabric and improve blood circulation in the leg, preventing blood clots and reducing fluid build-up. Keeping the affected leg elevated while at rest is a good idea as well. If the ulceration is arterial, then it should be evaluated by a vascular surgeon and treated accordingly.

Then, if necessary, surgery can be performed. In contrast, venous ulcers can be managed with conservative measures, though in some cases, surgery may be necessary to correct an underlying physiological disorder. Despite these risks, the main goal of treatment is to promote improved blood flow to the affected area and promote healing.

Shave therapy


The most common treatment for leg ulcers is shaving therapy. While the shave therapy procedure involves skin grafting, tangential excision is a better choice for trophically destroyed tissues.

This procedure is also effective in accelerating the healing process. The surgeon may remove the crural fascia, which is optional and controversial. The surgical technique may also include a skin graft from the underlying dermis, which is called autologous. Patients undergoing shave therapy have seen promising results.

The initial pain was less than four points on a 0-10 scale, and it was hardly noticeable during the first dressing change. It has been proven that shave therapy is a safe, effective treatment for leg ulcers.

However, there are some risks. In addition to a possible risk of allergic contact eczema, patients are at increased risk of developing type IV allergies.


Additionally, many ask


What is the most expedient method for healing an ulcer on the leg?


It’s possible that the following suggestions will speed up the healing process for your ulcer.
Make an effort to stay active by going for walks on a regular basis.

Keep the leg that is hurting you up at all times, including when you are sitting or lying down. Perform regular leg exercises by moving your feet up and down and turning them at the ankles. This will help strengthen your legs.

What is the primary contributor to the development of chronic leg ulcers?


The illness of the veins in the leg is the underlying condition that is responsible for chronic leg ulcers more often than any other. Over two-thirds of all leg, ulcers are caused by venous illness, making it the most common cause. It is possible that in some instances two or more conditions are simultaneously causing damage to the body.

What does it mean if you have ulcers in your legs?


Ulcers of the leg are incapacitating and significantly lower the quality of life for patients. Venous disease, arterial disease, and neuropathy are the most frequent underlying conditions. Infectious infections, metabolic problems, and hematological disorders are some of the less common causes of this condition.


What are the early warning indicators if someone has a leg ulcer?


Pain, itching, and swelling in the leg that is afflicted are some of the signs that someone has a venous leg ulcer. In addition to this, the skin around the ulcer may become discolored or thickened, and the wound itself may create a discharge with a putrid odor.

If you suspect that you have a leg ulcer, you should make an appointment with your primary care physician as soon as possible so that the ulcer can be treated by a specialist.

Are leg ulcers serious?


An ulcer on your leg that takes a very long time to cure is known as a venous skin ulcer. This is typically caused by poor blood circulation in the limb. They may just last a few weeks or they may persist for many years.

They are sometimes referred to as “venous leg ulcers” by medical professionals. If you choose not to get treatment for them, they may eventually develop into more serious issues.

Can you tell me about the most recent treatment for leg ulcers?


The use of topical oxygen therapy, also known as TOT, is a relatively new technique for the treatment of venous leg ulcers that are difficult to heal. It is not necessary to have a full-body compression chamber in order to use TOT because it is delivered directly to the wound.

Ulcers on the leg provide a risk for cancer.


Squamous cell carcinoma is the most prevalent kind of cancer that can develop from chronic leg ulcers, which can develop into any of the other types of chronic leg ulcers.

If not diagnosed at an early stage, these ulcers, which are also known as Marjolin’s ulcers, have a terrible prognosis and a high potential for spreading to other parts of the body.

How can you protect yourself from getting leg ulcers?


Dropping some pounds People who are overweight are at a much-increased risk of developing venous ulcers. It is recommended that you participate in regular physical activity and consume a diet that is both nutritious and balanced if you want to shed some pounds.

In addition to this, you should try to avoid sitting or standing for extended periods of time. Keeping your legs elevated for as much of the time as you can also be beneficial.

What are the consequences of leg ulcers that refuse to heal?


The increased likelihood of infection that comes with having an exposed sore is what sets venous leg ulcers different from other types of illnesses.

She recommends making an appointment with a physician or nurse practitioner as soon as possible if you have a wound that hasn’t healed after two to three weeks. They will do an assessment and then make a referral for you to a wound care center.

Ulcers of the leg might result in amputation.


Leg ulcers are dangerous. In point of fact, they are even capable of causing amputations. The good news is that although leg ulcers can result in the loss of a portion of the leg due to amputation, these persistent sores almost seldom result in the loss of a foot or a leg. 15 Aug 2018



In conclusion, leg ulcers are primarily caused by poor circulation in the legs, often resulting from chronic venous insufficiency. This condition leads to blood pooling and increased pressure, damaging the skin and tissues and ultimately causing ulcers.

Other factors such as arterial disease, diabetes, and inflammatory conditions can also contribute to the development of leg ulcers. Secondary factors like infections, trauma, obesity, smoking, and immobility can further exacerbate the condition.

Addressing the underlying cause and managing these factors are vital for the effective treatment and prevention of leg ulcers. It is important to seek medical attention and follow a comprehensive care plan to promote healing and improve the quality of life for individuals with leg ulcers.






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