Leg ulcer

A painful and debilitating condition

Mainly affects old age people

Causes

More than 90% result from arterial disease, venous disease, or neuropathy.

Trauma

Obesity

Immobility

Vasculitis (rheumatoid arthritis, SLE, PAN),

Malignancy

Osteomyelitis,

lymphoedema

Self-inflicted

Shin

Toes

Overpressure points (under the heel, over malleoli)

Above medial or lateral malleoli of the ankle

Sole of foot

Overpressure points

Duration of ulceration

Pain—painful, unless neuropathic when often painless

Mobility

Past history of ulceration, DVT, or varicose vein surgery

History of trauma to the limb

Systemic disease—e.g. Diabetes, peripheral vascular disease

Arterial ulcers refer to vascular surgery

Diabetic foot ulcers refer to a specialist diabetic foot team

Venous ulcers If ABPI >0.8, can be managed in the community with graduated compression bandaging

Change dressings twice weekly

Keep skin under the bandage moist with simple emollients

Treat surrounding eczema with topical steroids.

Analgesia.- Ibuprofen

Elevation of the leg when resting

Weight loss strategies if obese