By Bruce Greenfield, D.P.M., chief of Podiatry, Delaware County Memorial Hospital
Chronic venous insufficiency occurs when the leg veins do not allow blood to travel back to the heart. It has been estimated that 2.5 million people suffer from venous insufficiency, and approximately 20 percent of them develop venous ulcers. Venous ulcers are the most common ulcerations that occur in the lower extremities.
These ulcerations typically occur on the inside portion of the leg just above the ankle. The early warning signs of problems with veins in legs are swelling of the legs; veins becoming prominent and more visible (indicating varicose veins); brown, purple or red discoloration in the lower leg area; and tiredness or aching in the legs.
A brief lesson in anatomy can help to explain the cause of venous ulcerations. Arteries pump blood from the heart down to the feet, and veins bring the blood back up to the heart. There is less pressure to pump the blood up the veins to the heart and to prevent the blood from flowing back in the wrong direction. Numerous one-way valves in the veins prevent the backflow. When these valves are not working properly, the blood flows backwards in the veins causing them to enlarge. When veins enlarge, which is known as dilating, the blood stagnates resulting in varicose veins. When the blood stagnates, proteins leak out of the veins into the tissues—which may cause irritation and inflammation of the skin. The inflammation and irritation of the skin are precursors of an ulcer. Oftentimes, skin inflammation will result in an itching sensation. When scratched, the fragile skin breaks down resulting in the beginnings of an ulcer. When the skin is inflamed and weakened, any irritant—such as a bug bite, scratch, or burn—can cause an ulcer to develop.
An ulcer develops when the surface layer breaks down, revealing the tissues below the skin layer. It will look like a deep scrape or sore, and there will usually be moisture or fluid draining from the opening. If the ulcer becomes infected, the drainage will become thicker, there may be an odor, and there will be redness around the ulcer.
If a patient is diagnosed with venous insufficiency there are certain preventive measures that should be followed to prevent venous ulcers from developing:
- Wear compression stockings at all times during the waking hours. They are not required in bed.
- Elevate the legs whenever possible.
- Apply a moisturizing cream to the legs daily to prevent dryness. If there is any itching, avoid the urge to scratch and get a prescription for a cortisone cream to suppress the itching.
Venous ulcers can be easily treated when they are small and in the early stages. It is necessary to use some form of compression around the leg to help the veins to work properly and prevent back flow of blood. It is also necessary for a physician to evaluate the wound to make sure that an infection is not present.
A patient must see their doctor immediately if they suspect an ulcer is developing in their leg. Treatment at an advanced wound care center will provide the most effective treatment to heal the wound as quickly as possible. The sooner a wound is closed the less chance there will be for complications, such as infection, to develop.