Leg ulcer
Leg ulcer
A painful and debilitating condition
Mainly affects old age people
Causes
More than 90% result from arterial disease, venous disease, or neuropathy.
Other causes
Trauma
Obesity
Immobility
Vasculitis (rheumatoid arthritis, SLE, PAN),
Malignancy
Osteomyelitis,
lymphoedema
Self-inflicted
Common sites
Arterial
Shin
Toes
Overpressure points (under the heel, over malleoli)
Venous
Above medial or lateral malleoli of the ankle
Neuropathic
Sole of foot
Overpressure points
History
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
Management
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
Venous Ulcer with granulation tissue
Chronic venous ulceration with hyperpigmentation
Chronic venous ulceration
Chronic venous ulceration with lipodermatosclerosis
Chronic venous ulceration with Oedema and hyperpigmentation
