Venous leg ulcer - Treatment 

Treating a venous leg ulcer 

With appropriate treatment, most venous leg ulcers will heal within three to four months.

Treatment should always be carried out by a healthcare professional trained in compression therapy for leg ulcers. Usually, this will be a practice or district nurse.

Cleaning and dressing the ulcer

The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This will provide the best conditions for the ulcer to heal.

A simple, non-sticky dressing will be used to dress your ulcer. This will usually need to be changed once a week. Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.

Compression bandages

To help improve the circulation in your legs, your nurse will need to apply a firm compression bandage over the affected leg. These bandages are designed to squeeze your legs and encourage blood to flow upwards, towards your heart.

There are many different types of bandage used to treat venous leg ulcers, which can be made up of two, three or four different layers. The application of a compression bandage is a skilled procedure and should only be done by a healthcare professional trained in leg ulcer management.

Bandaging of the leg is usually done after the ulcer has been dressed. The bandage is changed once a week, when the dressing is changed.

When compression bandages are first applied to an unhealthy ulcer, it usually becomes more painful. Ideally, you should have paracetamol or an alternative painkiller prescribed by your GP. The pain will lessen once the ulcer starts to heal, but this can take up to 10-12 days.

It’s important to wear your compression bandage exactly as instructed by your nurse. If you have any problems, it's usually best to contact your nurse, instead of trying to remove it yourself. If the compression bandage feels a little too tight and is uncomfortable in bed at night, getting up for a short walk will usually help. 

However, if you get severe pain at the front of your ankle or on the top of your foot, or if your toes become blue and swollen, you will need to cut the bandage off. Once you remove the bandage, make sure you keep your leg highly elevated and contact your nurse as soon as possible.

Treating associated symptoms

Swelling in the legs and ankles

Venous leg ulcers are often accompanied by swelling of your feet and ankles (oedema), which is caused by fluid build-up. This can be controlled by compression bandages.

Keeping your affected leg elevated whenever possible, ideally with your toes at the same level as your eyes, will also help ease swelling. You may find it helpful to put something firm  such as a rigid suitcase  under the end of your mattress, to help keep your legs raised while you sleep.

You should also keep as active as possible and aim to continue with your normal activities. Regular exercise, such as a daily walk, will help reduce leg swelling. However, you should avoid sitting without your legs raised or standing still for longer than an hour at a time.

Itchy skin

Some people with venous leg ulcers develop rashes with scaly and itchy skin.

This is sometimes caused by a condition called varicose eczema, which can be treated with a moisturiser (emollient) and occasionally a mild corticosteroid cream or ointment. In severe cases, you may need to be referred to a dermatologist (skin specialist) for treatment.

Itchy skin can also sometimes be caused by an allergic reaction to the dressings or creams applied by your nurse. If this happens, you may need to be tested for allergies.

It’s important to avoid scratching your legs if they feel itchy, because this could damage the skin and lead to further ulcers.

Looking after yourself during treatment

To help your ulcer heal more quickly, follow the advice below:

  • Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse.
  • Whenever you are sitting or lying down, try to keep your affected leg elevated.
  • Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation.
  • Stop smoking, eat a healthy diet and moderate your alcohol consumption. This can help the ulcer heal faster.
  • Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear.

You may also find it helpful to attend a local healthy leg club, such as those provided by the Lindsay Leg Club Foundation, for support and advice about living with a leg ulcer.

Treating an infected ulcer

An ulcer will sometimes produce a large amount of pus and become more painful. There may also be some redness around the ulcer. These symptoms may be a sign of infection.

If your ulcer becomes infected, it should be cleaned and dressed as usual, although you may need to stop wearing your compression bandage until the infection has cleared.

You should also keep your leg elevated whenever possible, and you will be prescribed a seven-day course of antibiotics.

The aim of antibiotic treatment is to heal the infection. However, they have no beneficial effect on ulcer healing and should only be used in short courses, in order to treat ulcers that have become infected.

Follow-up

You should visit your nurse once a week to have your dressings and compression bandages changed. They will also monitor the ulcer to see how well it is healing. Once your ulcer is healing well, you will probably need to see your nurse less often.

After the ulcer has healed

Once you have had a venous leg ulcer, there is a significant chance another ulcer could develop within the next few months or years.

The most effective method of preventing this is to wear compression stockings at all times when you are out of bed. Your nurse will help you find a stocking that fits correctly and that you can manage yourself.

Various accessories are available to help you put them on and take them off.

Read more about preventing venous leg ulcers.


Page last reviewed: 27/03/2014

Next review due: 27/03/2016

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Comments

The 12 comments posted are personal views. Any information they give has not been checked and may not be accurate.

mikeattor said on 02 October 2014

When I developed a leg ulcer 15 months ago I went to the doctors and began treatment at the Leg Ulcer Clinic. I am rather disappointed to say that, although they certainly followed all the treatment details described on this site the ulcer increased in size 20 fold. The pressure stocking did not just 'hurt for the first few days, it almost crippled me and has damaged toes. I have found that by using this much less often there is great improvement. When the ulcer got worse and I was unable to stand the pain after three days I used to change the dressing for some relief, It was almost always worse and, although it looked and smelled infected samples sent to the hospital on five occasion came back negative. They were still cleaning with tap water! They were not pleased by my not leaving the dressings for a week so they tried bandages so that I could not remove them. After one week I had to be taken to the surgery in serious pain. On removing the bandages the ulcer had doubled in size, was infected and smelled badly. I told them I had been on this web site and frankly found the treatments suggested to be nonesense. I began to use TCP for cleaning the wound after bathing and ordered a much lighter stocking. There was immediate improvement. I was told not to use TCP and leave the dressing for longer than two days. The ulcer turned bad again. After 14 months I had had enough, especially as treatments that failed badly were being 'tried' for the third time. Each time the black scab was removed as recommended here it bled badly and opened up further. I insisted on the now frowned upon inadine patches with a breathing fabric plaster over the top. I insisted that I would wash, dry and re-dress every two days and the scab must not be touched. It has healed amost completely within three weeks. I have spoken to others who have descibed similar, only one is still going for treatment after five years. The other had to go to hospital. I think some review is needed.

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Brunnhilde said on 30 July 2012

I have had an ulcer on my ankle for 30 years. No one has been able to heal it. It was caused by the Registrar of my local hospital making an incision on my ankle (inner) in order to inject coloured fluid to xray my veins. It developed into an ulcer. The pain has been unbearable at times, often infected and has been treated with numerous anti-biotics. My ulcers, now 4 of them, are treated thrice weekly by district nurses, lovely people and very sympathetic, but ALL patients are treated with the same dressings. Everyone is different and the ulcers should also be treated as if they, too, are different..
The exudate is vile, the bandages are wet right through
within very few hours. I have two arthritic hips AND shoulders and am able to walk very little with crutches. I spend most of the day in a wheelchair thus getting no exercise. I have searched for a diet to help but they are also all different. What can I eat, or avoid, to get these wretched things healed I wonder?


























































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pompey jake said on 10 June 2012

had a leg ulcur at 19!

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pompey jake said on 10 June 2012

well i had my first leg ulcer at 19! very young then at 22 and now i have one now at 28. but i put it down to job im on, on site at high level tower climbing up and down all the time gutted

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jayjay48 said on 02 May 2012

have just read all of above and find it refreshing to see that someone around my age (48) has a leg ulcer...i thought it was always the older population that got them....i also have had ulcers on and off since 2006 and find it very hard coping with them and many times have been in tears,they get you down and i find it frustrating when i cant do things like i use to...im trying to hold down a full time job and also have a son of 9yrs who obviously wants his mum to join in on games etc...i have only just been offered an op to hopefully prevent anymore but have been told its 50/50 if it works,im willing to take the chance...im so fed up with being in this situation i feel its got to be worth a try...my ulcer at the moment has been in compression since january and is very slowly getting better...the problem i also find now is my hips are now getting so painful and climbing the stairs at time can be hard.i just hope once this bandage is off they also will be pain-free!!

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Splashofcolour said on 24 April 2012

I found this site told me pretty much everything that I already knew about venous ulcers. I have had problems on and off since 2005 with ulcers, varicose eczema, odema and cellulitis despite having 2 varicose vein ops and wearing compression bandages and stockings. At present I have 2 ulcers which cause me severe pain some days and next to no pain other days. I find that on bad days my co-codamol is unable to cope on it's own and need Dihydrocodeine as back up. Also find Diclofenac stops my feet feeling like they have seized up. My ulcers have always been on my ankles. I am now on the waiting list to have a 3rd V V op. I have had 20 ulcers over 7 years and I am only 46. My message to everyone out there with ulcer problems is, don't give up. I know sometimes it's difficult, but there are people out there with far more serious things wrong with them. They will heal up eventually. Sometimes I only get a few months without them before they come back, but a few months is better than none at all.

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Jacq22 said on 20 April 2012

My mum who is 80 has developed horrific venous ulcers in the last 6 months. The huge amount of fluid which exudes from them causes her extreme distress as two hours after dressing, the yellow mess is flowing into her shoes. I am at my wits end and she is now in hospital with an infection. We thought she was developing dementia it was so bad. Nothing contains this fluid. The dressings hold it until it overflows within the thin spongy dressing, but the inevitable smell and mess is so distressing and makes a mess of clothing and bedding - there must be a better way of dealing with this. It is so awful. Surely in this day and age there is a better way of dealing with this than waiting with the awfulness of the situation until the next visit by the most excellent district nurses who try so hard to help. This is truly most distsressing for both patient and carers. I really feel home care is not appropriate in the most chronic cases where repeated fresh dressing are required very frequently.

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faffi said on 11 January 2012

I have read all the above information about the conservative methods of the treatment of leg ulcers, but find that an important part of treatment is missing. We have an important agent to help the aterflow of liquids from the legs (oedema) and that is the use of the leg muscles. Treatment must include activites that will encourage the use of muscles to pump up the liquids that cause swelling.

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Moggi said on 05 March 2011

As this is the first time I have used NHS Choices, I cannot Comment on how the treatment went. But I found the reasonable answer to my Lipodermatosclerosis problem has helped. If treatment by creams do not work, then I shall consult my Doctor. The sorter system works well, at least for me.

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grumpyb said on 06 February 2011

In my experience it was the application of a multi layer bandage system that caused all of my pain, A small but perhaps deep bruise led to my leg ulcer. A doppler test led to the 4 layer bandaging system. This cause extreme pain, not reduced by copious painkillers, almost total lack of sleep and immobility. The only relief came with the replacement of bandages by a pressure stocking. Absolutely no pain, able to walk and exercise.
This page needs to be reviewed sooner that scheduled. It should include more reference to the many technical dressings that are available.

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Pete S said on 11 August 2010

My previous ulcer took two years to heal up after which I was prescribed pressure stockings. After about one year of relief the ulcer is back with a vengeance & now measures 8 x6 inches & exudates constantly. The treatment nurses are doing all the right things and I'm convinced now that it is extremely important to make sure the leg is measured correctly for the right strength stocking.
I hope this info might be of some use and if anyone has any advise it will be gratefully received

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clamcyp said on 04 July 2009

I searched your index first under "ulcer", then under "V for Vein/venous". I tried "S for Skin" and several at random until I found Venous Ulcers under "L for leg". May I suggest either cross-referencing the index or adopting the method used by the Services, such as "Pots, Chamber, Crested, Officers for the use of".

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