Topic Overview

Venous skin ulcers develop when the lower leg veins are weakened and cannot efficiently move the blood back toward the heart. Pooled blood and fluid in the lower legs then leads to tissue breakdown. You can prevent or heal a venous skin ulcer by helping your blood circulate back toward your heart.

Leg elevation

During sleep. While you are sleeping, you can help your blood circulate back to your heart by elevating your feet above the level of your heart. Prop the foot end of your bed up on 15 cm (6 in.) to 20 cm (8 in.) blocks.

While awake. During waking hours, try to elevate your legs above the level of your heart for 30 minutes, 3 to 4 times a day.

Elevating your legs may be all the treatment you need if you have mild venous insufficiency. But if you continue to have problems with venous skin ulcers, you will need additional treatment.

Exercise

Doing regular foot and ankle exercises can help strengthen your leg muscles and improve blood flow in your legs. While you are sitting (or standing), flex your ankles by pointing your toes away from you and then pointing them up. Do 10 repeats of the exercise several times each day. This exercise is especially important for people who need to sit or stand for long periods of time.

Walking is also good exercise for improving blood flow in the legs.

Compression

Compression therapy is the main treatment for venous skin ulcers. If you have a venous skin ulcer, your doctor may first want to reduce the buildup of fluid in your lower leg. After your lower-leg swelling has been reduced, compression is used to create more constant pressure on both the flexing and resting leg muscles. There are several types of medical devices for compression therapy. Your doctor will recommend the type that will work best for you. If you have an open wound, it will be covered with a dressing before the compression device is applied.

Unna boot. This is a stiff bandage made with gauze and zinc oxide paste wrapped around the lower leg. This type of bandage improves blood flow by putting greater pressure on leg muscles when they are flexing and less pressure on the leg during rest. It is used to reduce a large amount of swelling in your lower legs. An Unna boot can be left on for 7 to 10 days.

Long-stretch bandage or short-stretch bandage. These are flexible bandages that are wrapped tightly around the lower leg to reduce swelling and improve blood flow. The bandages are used to help heal a venous ulcer. The ulcer is covered with a dressing before the bandage is put on. The bandage is put on the leg by a health professional. Caregivers can be trained to apply them too.

Active compression pump. This pump goes around your lower leg. It has air bags that inflate and deflate periodically to force blood to flow out of your lower leg toward your heart. The pump can be used to help heal a venous ulcer that has not been helped by other types of treatment. The pump is used for several hours each day. It is used along with compression stockings.

Compression stockings. Specially fitted compression stockings are designed to help prevent fluid from pooling in the legs. You should wear these stockings every day from the time you wake up until you go to bed. Remove them only for bathing and sleeping. They can help venous skin ulcers heal and help prevent them from coming back.

For tips on using compression stockings, see:

• Compression Stockings: How to Use Them.