Venous ulcers of the leg occur because the veins become stretched, which prevents the valves in the veins from fully closing.
Lack of exercise and lack of physical activity make the problem worse. The calf muscle pump refers to the collection of veins located deep inside the leg and that are supported by powerful muscles that help push blood back up to the heart. This muscle group is helped by the veins themselves with 1-way valves that prevent blood from flowing backward. A well-functioning calf muscle pump is important to healthy leg veins. When veins are stretched or unhealthy, or the calf muscle pump is not working well, it can lead to ambulatory venous hypertension, or high blood pressure, in the veins. This high pressure hurts blood flow and nutrition to the skin and, if not corrected, leads to skin breakdown.
Tests look at blood flow in the legs by checking the leg pressure with cuffs around the legs. Ultrasonography is used to check the blood flow. In some cases, skin cultures are used to check for infection, or biopsy may be needed.
Compression therapy and exercise can improve blood flow in the veins and help heal the ulcers. Compression therapy is usually achieved with elastic and semi-elastic wraps, stockings, or even pneumatic compression systems. When ulcers are present, dressings are applied under the compression wraps to help the wounds heal. Wound management health care professionals, including dermatologists, can recommend the best wound dressings and compression. Wound dressings are complicated and may require daily or twice-daily care, including cleansing and the use of topical medications and special types of bandages to protect the ulcer and help it heal.
Exercise should focus on strengthening the calf muscles. This may be as simple as standing heel rises performed several times a day, repeated 20 to 30 times, or full-stride walking or stair climbing. In all cases, supportive compression garments and good-fitting athletic shoes should be worn. When sitting or lying down, raising the leg to the height of the hip and keeping it up after exercise will limit swelling.
Supervised physical therapy may also be of benefit. The therapist can plan custom exercises and can use technologies such as electrical stimulation, ultrasound, and pneumatic compression to help ulcers heal.
Association for the Advancement of Wound Carehttp://www.aawconline.org
American Board of Wound Managementhttp://www.abwmcertified.org.
To find this and other JAMA Dermatology Patient Pages, go to the Patient Page link on the JAMA Dermatology website at http://www.jamaderm.com.
Conflict of Interest Disclosures: None reported.
McCulloch J. Venous Ulcers. JAMA Dermatol. 2015;151(9):1044. doi:10.1001/jamadermatol.2015.58