Who needs treatment for leg ulcers - or to prevent leg ulcers?

Although it is obvious who has an ulcer, it can be more difficult for the public (as well non-specialist doctors and nurses) to spot those people who are heading towards ulceration.
 
With improving communication, many people with severe varicose veins are seeking specialist opinions and are quite correctly bypassing doctors who give the old advice of "leave them until they cause a problem".

However, many people most at risk of ulceration do not have any varicose veins to see. These people have SUPERFICIAL VEIN VALVE FAILURE (see previous pages) - having inflammation of the skin, but the veins have not dilated and so no varicose vein can be seen. One of the early warning signs of this is a RED or BROWN PATCH of skin on the lower leg, just above the ankle, usually on the inner side (see picture on the RIGHT). This is usually called Lipodermatosclerosis (LDS).

Lipodermatosclerosis of ankle - often mis-diagnosed as "phlebitis" - shows underlying venous reflux and heading for an ulcer

If this is left without treatment (or if creams or pressure stockings are given instead of referral to a Vascular Surgeon) this slowly deteriorates to dark brown staining - called HAEMOSIDERIN. If this is left longer, white patches appear in the skin, where the skin itself is breaking down (see picture on Right). These rapidly go on to complete breakdown and ULCERATION. At any stage in this deterioration, a referral to a specialist vascular surgeon is likely to result in definitive treatment that not only stops further deterioration but often reverses the whole process.

Haemosiderin deposition at ankle (brown stains) - heading for ulceration due to venous reflux

One note of CAUTION - as you will have seen in the previous pages, the patient MUST be able to use the LEG PUMP - therefore if the patient is not able to walk of has poor ankle movement, it is unlikely that surgery will be able to help. There is little point in stopping the reflux after pumping, if there is no pumping in the first place.
So in a nutshell:

Those who need assessment for treatment:

● Anyone with a LEG ULCER who is able to walk and who has reasonable movement of the ankle joint
● Anyone with discolouration of the skin on the lower leg usually just above the ankle - can be pink, red, brown or shiny hard skin
● Anyone with severe varicose veins