Venous Ulcers

The arteries take the blood from the heart to the legs (and the other parts of your body). The veins take the blood back to the heart. Don’t get arteries and veins confused.

The arteries have a pretty easy job. They get to work with the heart which is a strong pump to send the blood to the legs. If you have diabetes and/or you smoke, you will develop artery disease which can affect the ability to get blood to the legs. We will talk about that later.

The veins have a hard job. They have to take the same amount of blood from the feet back to the heart, but there is no pump in the feet to send the blood back, and they have to work against gravity. So, the veins send blood back to heart by constricting a segment of the vein and pushing the blood up a short distance. A valve shuts to keep the blood from falling down into the foot, and then another segment of the vein contracts pushing the blood up further, and another value shuts, and so on. There are a lot of things that can go wrong with this system.

Being overweight makes it harder for the veins to get the blood back to heart. Jobs that involve a lot of standing can damage the veins, as can having a lot of children, or blood clots. When the veins begin to “give out”, blood falls back into the legs and they swell. Blood leaks out from the veins.

When the blood cells leak out from the veins, the red blood cells die and leave behind the iron oxide pigments that carry oxygen. This stains the skin brown, called “hemosiderin” staining.

Your blood not only carries red cells, it also carries white cells which are designed to fight infection. These white cells contain chemicals they used to kill bacteria. However, when the white cells die in the skin, they release their chemicals like a “suicide bomber”. These chemicals can cause the skin to break down. It is this process we call a “venous stasis (stasis means “stagnant”) ulcer.

Venous stasis ulcers may be the most common type of leg ulcer.

Perhaps 1% of the U.S. population has venous insufficiency (blood not getting back to the heart due to damage in the leg veins, causing the legs to swell and sores to develop). Perhaps 2% of those patients will develop a venous stasis ulcer. That means that about 500,000 Americans develop a venous stasis ulcer every year.

Because the vein trouble which causes these ulcers may not be something “fixable”, it is estimated that about 80% of the time, even after they get healed, venous leg ulcers happen again.

Some studies have shown that it costs between $2,000 and $10,000 to heal a venous leg ulcer, even though the treatments for them are very well understood and accepted.

Patients with venous leg ulcers ALWAYS have leg swelling.

They almost always have brown discoloration of the skin (hemosiderin) even though they may be dark skinned naturally, they still have staining of the skin due to hemosiderin.

Usually, patients with venous disease have hardening of the skin which is called “lipodermatoclerosis.”

Venous ulcers are usually irregular in shape but you can easily tell where the edges are if you had to trace it.

Venous ulcers NEVER are deep enough to expose bones or tendons. If a leg ulcer has a bone or tendon exposed, the ulcer is more complicated than just a vein ulcer.

Venous ulcers can hurt.