A venous ulcer is a chronic wound, typically found on the lower leg or ankle, that fails to heal due to underlying vein disease. Identifying these wounds by their distinct visual characteristics is the first step toward seeking appropriate care. This article describes the appearance of the ulcer and the telltale changes in the surrounding skin.
The Underlying Cause of Venous Ulcers
Venous ulcers are a direct result of Chronic Venous Insufficiency (CVI), a condition where leg veins struggle to return blood efficiently to the heart. Normally, one-way valves within the veins keep blood flowing upward against gravity. When these valves are damaged or weakened, blood pools in the lower extremities, leading to increased pressure known as venous hypertension.
The sustained high pressure forces fluid, plasma, and red blood cells to leak out of the capillaries and into the surrounding tissue. This accumulation of fluid, or edema, causes inflammation and reduces the delivery of oxygen and nutrients to the skin. Over time, this hostile environment weakens the skin, making it fragile and unable to repair itself after even a minor injury, eventually leading to the formation of an open wound or ulcer.
Defining Characteristics of the Wound Bed
Venous ulcers most frequently develop on the inner part of the lower leg, specifically above the ankle bone in what is often called the “gaiter area.” The wounds are typically shallow, meaning they do not penetrate deeply into the tissue, but they are often quite large and irregularly shaped. Unlike wounds with neatly defined borders, a venous ulcer usually has sloping or gradual edges that are not sharply “punched out.”
A common feature of the wound bed is the presence of granulation tissue, which appears ruddy or beefy red, indicating the body is attempting to heal. However, this base may also be covered with a yellowish, non-viable tissue known as fibrin or slough. Venous ulcers are notoriously “wet” wounds, producing moderate to heavy amounts of thin, watery drainage, or serous exudate, resulting from the ongoing fluid leakage.
Visual Changes to the Skin Surrounding the Ulcer
The skin surrounding a venous ulcer displays distinct visual changes that signal underlying CVI. One common sign is hemosiderin staining, which presents as a dark purple, brown, or rusty discoloration. This occurs when red blood cells leak from capillaries and break down, releasing iron (hemosiderin) into the tissue, permanently staining the skin.
Another significant change is lipodermatosclerosis, an inflammatory condition that causes the skin and underlying fat tissue to harden and thicken. In its advanced stage, this hardening can narrow the lower leg just above the ankle, creating a distinctive “inverted champagne bottle” shape. Accompanying these changes is stasis dermatitis, where the skin becomes red, itchy, and scaly, and non-pitting edema, which is swelling that does not leave a temporary indentation when pressed.
Next Steps and Seeking Medical Help
If you notice a non-healing wound or any described skin changes on your lower leg, consult a healthcare professional, such as a vein specialist. Venous ulcers rarely heal without medical intervention because the underlying high-pressure problem (CVI) must be addressed. Treatment typically involves improving circulation, often through compression therapy, alongside wound care.
Seek immediate medical attention if the wound shows signs of infection, which can worsen quickly. Warning signs include a foul odor, increased pain, spreading redness or warmth around the ulcer, or drainage becoming thick, pus-like, or green. Early diagnosis and treatment are crucial to prevent the ulcer from becoming chronic and to reduce the risk of serious complications, like cellulitis.