Diagnosing a venous leg ulcer 

If you think you may have a venous leg ulcer you should see your GP, as the condition is unlikely to improve without specialist treatment.

A diagnosis is largely based on your symptoms and a physical examination of your affected leg, although additional tests may be required.

Physical examination and medical history

Your GP or practice nurse may examine your leg, both when you are standing up and lying down. Varicose veins will be more obvious when you are standing up, and it will be easier to look at the ulcer when you are lying down.

They will ask whether you have any additional symptoms associated with venous leg ulcers, such as swelling in your ankles and discoloured or hardened skin. They will also feel your pulse at your ankles to make sure the arteries in your leg are working properly.

Your GP or nurse may try to determine the cause of the ulcer by asking about any underlying conditions you may have, such as diabetes or deep vein thrombosis (DVT), and any previous injuries, ulcers or surgery you may have had on your affected leg.

Doppler study

To rule out peripheral arterial disease (a condition affecting the arteries) as a possible cause of your symptoms, your GP or nurse will carry out a test known as a Doppler study.

The test involves measuring the blood pressure in your ankles and comparing it to the blood pressure in your upper arms. These measurements are taken with a Doppler probe, which uses sound waves to determine the flow of blood in your arteries.

The arterial blood pressure should be about the same in your arms and legs. However, if you have peripheral arterial disease, the blood pressure in your ankles will be lower than that in your arms.

It is important to carry out this check before a diagnosis is made because the treatment for peripheral arterial disease is different to that for venous leg ulcers. One of the main treatments used for venous ulcers is wearing compression bandages to improve the circulation in your legs, but this can make things worse if you have peripheral arterial disease.

Read more about how venous leg ulcers are treated.

Referral to a specialist

In some cases, your GP or nurse may decide to refer you to a specialist in conditions affecting the blood vessels (vascular specialist) for further examination and treatment.

For example, you may be referred to a vascular specialist if your GP or nurse is unsure about your diagnosis, or if they suspect your ulcer may be the result of certain underlying conditions, such as diabetes or rheumatoid arthritis.

If you are referred to a specialist, you may have a further test called a duplex ultrasound scan to check the health of the blood vessels in your legs in detail. This entirely pain-free scan uses sound waves to build up a picture of the blood vessels in your legs, then assesses the flow of blood through them.

Page last reviewed: 26/03/2014

Next review due: 26/03/2016