Venous ulceration is by far the most common cause of leg ulceration and occurs due to the failure of the venous system to return the blood to the heart efficiently. This is due to failure of the valves in the veins somewhere in the legs.  In the normal state, the blood is pumped back up the legs with each heartbeat and is prevented from refluxing back down the valves by valves situated inside the veins. If the valves do not work properly blood drains back down the leg and builds up pressure in the small veins and capillaries. This increased pressure can lead to blood being forced out into the tissues, where the blood cells will be broken down in the tissues. This creates an inflammatory reaction in the tissues which can lead to tissue breakdown and ulcer formation. 

This valve failure can occur in either the deep venous system or the surface venous system. In the surface system this may also cause varicose veins and leg swelling and it is common for patients with venous ulceration to have varicose veins and swollen legs. 

The management of venous ulcers involves the correction where possible of the reduced return of the blood to the heart. This can be done by wearing graduated compression stockings. These stockings work well in the short term but are difficult to wear in our hot climate. This is not a permanent cure. When the ulcer is caused by failure of the surface system, correction of the bad "refluxing" veins will permanently improve venous blood flow back to the heart. This can be done with either endovenous laser ablation, ultrasound guided sclerotherapy or surgery

Clinical Features of Venous Ulceration

  1. Copious drainage
  2. Swollen and indurated leg
  3. Usually painless
  4. Granulation tissue at the base
  5. Pulses present although they may be hard to feel
  6. Often in the gaiter distribution of the leg