Leg ulcers are open sores that develop on the skin, typically on the lower leg, and can be slow to heal. These wounds extend beyond the superficial layers of the skin. While minor sores may heal, leg ulcers often indicate an underlying health issue that requires medical attention to prevent worsening.
Types of Leg Ulcers
Leg ulcers are broadly categorized by their underlying cause, which often relates to issues with blood circulation.
Venous Ulcers
Venous ulcers, the most common type, result from chronic venous insufficiency where faulty leg vein valves cause blood pooling, leading to increased pressure and tissue breakdown. They account for a significant majority (70-90%) of all leg ulcers.
Arterial Ulcers
Arterial ulcers develop due to poor blood flow, usually from narrowed or blocked arteries (peripheral artery disease). These ulcers are less common than venous ulcers, making up about 5% to 10% of cases.
Diabetic Ulcers
Diabetic ulcers arise in individuals with diabetes from a combination of nerve damage (neuropathy) and reduced blood circulation, often appearing on the feet but also on the leg.
Pressure Ulcers
Pressure ulcers, also known as bedsores, form when prolonged pressure cuts off blood supply to the skin, leading to tissue death. They commonly appear over bony prominences on the legs and feet in immobile individuals, though they can occur anywhere.
Visual Characteristics of Leg Ulcers
Each type of leg ulcer presents with distinct visual features that help differentiate them.
Venous Ulcer Appearance
Venous ulcers commonly appear on the inner part of the leg, just above the ankle, and are typically shallow with irregular, uneven borders. The wound bed often looks ruddy red with granular tissue, and there may be a yellowish discharge. The surrounding skin may be discolored brown or reddish-brown (due to hemosiderin deposits), and appear swollen, hardened, or shiny.
Arterial Ulcer Appearance
Arterial ulcers usually occur on the feet, toes, heels, or bony prominences, often “punched-out” with well-defined, symmetrical edges. These ulcers are frequently deeper than venous ulcers, sometimes exposing tendons or bone. Their wound bed may be pale, gray, or black due to necrotic (dead) tissue. The surrounding skin often looks thin, shiny, and hairless, and it may feel cool to the touch. Drainage is typically minimal, appearing dry.
Diabetic Ulcer Appearance
Diabetic ulcers often form on the sole of the foot, toes, or pressure points like the ball of the foot, though they can also affect the leg. These ulcers often have an irregular shape and may appear inflamed with surrounding discolored skin ranging from red to black. The wound can be deep, potentially exposing underlying tissues, and may have calloused margins. Drainage can vary from low to heavy, with an infected ulcer potentially producing foul-smelling pus.
Pressure Ulcer Appearance
Pressure ulcers are classified into stages based on their depth and appearance. A Stage 1 pressure ulcer presents as intact skin with a localized area of non-blanchable redness, which may be harder to detect on darker skin tones. A Stage 2 ulcer involves partial-thickness skin loss, appearing as a shallow open wound with a pink or red wound bed, or as an intact or ruptured serum-filled blister. Stage 3 ulcers show full-thickness skin loss where subcutaneous fat is visible, and the ulcer can appear crater-like with possible undermining or tunneling. Stage 4 pressure ulcers involve full-thickness tissue loss with exposed bone, tendon, or muscle, often with slough or eschar present.
Associated Symptoms and Complications
Leg ulcers often have symptoms beyond their visible appearance.
General Symptoms
Other symptoms can include itching, swelling (edema), and a feeling of tightness. The surrounding skin may also show changes like dryness, flakiness, or a rash.
Pain Characteristics
Pain is common, varying in intensity and type depending on the ulcer’s cause. Venous ulcers might cause a dull, aching pain that improves with leg elevation, along with a heavy feeling in the legs. Conversely, arterial ulcers are often very painful, with the pain worsening when the leg is elevated.
Signs of Worsening or Infection
Signs of worsening or infection include increased pain, spreading redness and warmth, increased or foul-smelling discharge (pus), and fever. Untreated infection can lead to serious complications like cellulitis or sepsis.
When to Seek Medical Attention
Initial Consultation
Consult a healthcare professional for any new or unexplained open sore on the leg, especially if it does not show signs of healing within two weeks. Leg ulcers rarely resolve on their own and typically require medical treatment to address the underlying cause and promote healing. Prompt evaluation helps prevent the ulcer from worsening and reduces the risk of complications.
Signs Requiring Immediate Attention
Seek medical attention if an existing ulcer shows signs of infection, such as worsening pain, increased redness or swelling, foul-smelling discharge, or fever. Professional assessment is advised if the ulcer grows larger or causes increasing discomfort. Self-diagnosis can be misleading; a healthcare provider can accurately diagnose the ulcer type and recommend management strategies.