- What is a leg ulcer?
- What causes a leg ulcer?
- What are the different types of leg ulcers?
- What can be done to prevent leg ulcers?
- What is the best way to care for a leg ulcer?
What is a leg ulcer?
A leg ulcer is a breakdown of an area of skin on the leg which extends into the lower layers and may produce discharge.
What causes a leg ulcer?
Leg ulcers develop due to problems with the circulation in the legs, either the veins or arteries. Ulcers that occur due to problems with the veins are called venous ulcers, while ulcers caused by problems with the arteries are called arterial ulcers.
What are the different types of leg ulcers?
Veins are vessels that collect blood from around the body and return it to the heart. The high pressure of blood in the larger veins deep inside the leg can damage the valves that regulate the flow of blood through them. This causes great pressure on the smaller veins nearer the surface of the skin, causing varicose veins. Because of this increased pressure, the nutrients leak out of these veins into the tissue around them. This results in malnourished skin, which breaks down more easily.
Leg ulcers can also develop as a result of problems with the arteries, which are large blood vessels that supply blood from the heart to the organs around the body. An obstruction of the artery, due to a narrowing of its walls, for example, can mean that areas such as the legs do not receive enough oxygen and nutrients. This results in unhealthy skin, which is more likely to break down and lead to the formation of an ulcer.
What can be done to prevent leg ulcers?
Problems with the veins
If a person has varicose veins, ensure that they do not stand for prolonged periods. Activities such as crossing the legs can also disrupt the flow of blood and lead to problems and so should be avoided.
- Elevating the feet It is helpful to elevate the feet on a footstool when sitting down, in order to relieve the pressure on their veins. Provided a person does not have high blood pressure, problems with their arteries or an underlying heart condition, the end of the bed can be elevated slightly to increase blood flow back to the heart.
- Support stockings Older women with varicose veins should be encouraged to wear support tights. Unisex knee and thigh length support stockings are also available to buy.
- Exercise Flexing the feet regularly when sitting, in order to enable the calf muscles to pump the blood out of the veins. Walking can also be helpful for this purpose.
- Diet Maintaining a healthy diet and a normal body weight helps to avoid excess pressure on the veins and arteries caused by obesity.
Problems with the arteries
- Pains in the legs If the person has problems with their arteries, it may appear as an intermittent pain in the legs which develops when they walk and is relieved by rest, known as intermittent claudication. Their feet may also appear cold and mottled.
- Cuts and scratches Because the blood circulation is poor, the supply of nutrients and oxygen to the legs is limited and the healing power of the skin is reduced. For this reason it is vital that the even the smallest scratches or cuts to the leg are avoided if possible, as an ulcer can develop quite quickly as a result. This can be done by moving obstacles out of the persons way, particularly things that are low down such as coffee tables or stools. Sharp corners on furniture should be avoided. Small children and animals should not be allowed to climb up on the elderly person as they can accidentally scratch their skin. Small cuts and scratches which inevitably occur should be promptly treated.
- Smoking Smoking can cause a disorder of the arteries known as atherosclerosis. This is a condition where the walls of the arteries become lined with fatty deposits. This leads to hardened, narrowed arteries resulting in a reduced blood flow around the body, especially to the legs. Smoking can also reduce the amount of oxygen in the blood circulating around the body and to the extremities, including the legs.
- Washing The skin should be washed with warm water and a very mild soap, and dried very gently, especially between the toes. It is important to inspect the skin regularly for signs of skin breakdown.
- Dry skin If the skin is dry, an emollient or lanolin can be massaged in. Toenails should be cut straight across and more difficult procedures should be referred to a chiropodist.
- Keeping warm While an older person should be kept warm with blankets, warm clothes and socks in cold weather, hot water bottles should be avoided. If they are experiencing problems with their circulation, the sensation in the feet is often not as good as before. For this reason, direct heat may not be perceived to be as hot as it is and can cause damage to the skin. The person should wear well-fitting shoes and socks to avoid constricting the blood flow around the feet.
- Exercise Gentle to moderate passive or active exercise should be encouraged if tolerated. This will promote the circulation.
What is the best way to care for a leg ulcer?
Keep wound covered
One of the most important aspects of caring for a leg ulcer is keeping the wound clean and free from harmful germs. For this reason, open wounds should be kept covered with a sterile dressing at all times.
Your doctor can arrange to have the leg ulcer dressed regularly by the public health nurse or at the local hospitals dressing clinic, if there is one nearby. Wounds generally tend to heal better when kept moist, so it is important that the dressing stays intact until it is due to be changed and that it is not removed.
Look out for infection
Keep an eye out for any signs of infection, which may be indicated by an increase in the amount of ooze from the wound, which can be seen on the dressing. The area of skin around the wound can become very red, hot and painful. You may not be able to see this, but take note if if the leg becomes more painful than usual. The sufferer may also have a raised temperature and sometimes can become temporarily confused or agitated when infection sets in.
If poor circulation in the veins is a problem, the leg is often bandaged with layers of bandages to increase the flow of blood back up the leg into the heart. It is important that these bandages are kept on and do not fall off or loosen.
With such large dressings, washing can be a problem , as the outer bandages should be kept dry. It can help to cover the dressing and leg with a clean black refuse sack and keep it out of the water while bathing or showering. It can help to use a plastic chair in the shower for the person to sit on if it is a walkin unit and to hand-hold the shower head to direct the flow of water away from the dressing.
A high calorie, high protein, high vitamin diet is recommended to help the skin to repair itself. Vitamins B and C are particularly important for repair of the cells that make up the skin. Iron will help to improve the uptake of oxygen in the blood. It is a good idea to talk to your doctor or public health nurse about this, as the person with a leg ulcer might have other medical conditions that restrict what they are allowed to eat. In this case they may refer you to a dietitian for advice.
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