What Causes Leg Ulcers?

Leg wounds or ulcers may begin with a small area of skin breakdown from trauma or pressure on a particular area. Patients with diabetes, history of smoking, and cardiovascular risk factors are more prone to developing ulcers that may not heal due to lack of blood flow to the area. A non-healing ulcer places the limb at risk for infection, gangrene (dead tissue) and limb loss (amputation). 


Wounds that do not heal within 30 days are considered non-healing and evaluation for venous disease as well as  peripheral artery disease is indicated.

What are the Signs/Symptoms of Ulceration?

Symptoms of extremity ulceration may include:

  • Skin breakdown (sometimes with fat or bone exposed)

  • Concomitant peripheral artery disease may exist with venous ulcers

  • Pain in the area of the ulcer

  • Drainage

  • Swelling

  • Weeping

​How are Leg Ulcers Diagnosed?

Evaluation for lower extremity ulcers/wounds should include: 

  • Lower extremity venous ultrasound 

  • Ankle-Brachial Index (ABI) to exclude underlying PAD

  • Lower extremity artery ultrasound (if indicated)

  • CT and/or MR angiography

  • Venography

  • Wound care center referral

  • Podiatry and/or orthopedics referral

What are the Treatment Options for Leg Ulcerations?

Treatment for non-healing lower extremity ulcers/wounds should involve a multi-disciplinary team that may include a vascular specialist, wound care physician, podiatrist, orthopedist, and infectious disease specialist. If venous blood flow in the area of the non-healing ulcer is compromised, catheter-based treatments (venous ablationthrombectomystenting) and/or bypass surgery may be indicated to restore venous return and allow for healing.