What is the underlying cause of leg ulcers?

The commonest underlying cause of leg ulcers is problems with the veins (a venous ulcer). The second commonest cause is problems with the arteries (an arterial ulcer).

Venous ulcers and arterial ulcers account for almost all leg ulcers. There are other causes but these are uncommon compared to these main two causes.

Although arterial ulcers are less common than venous ulcers, they are the most important to diagnose.

Firstly, they can often be treated by opening the arteries using an angioplasty balloon or stent, or sometimes a bypass graft.

Secondly, arterial ulcers are a very bad sign showing that the leg does not have enough blood supply to keep it alive. If this is the case, and a blood supply cannot be restored, gangrene is a possibility. Therefore it is important to know if a leg ulcer is arterial first (see the section on what sort of leg ulcer do I have?)

Once you know you do not have an arterial leg ulcer, then the chances are you had a venous leg ulcer.

The good news about having a venous leg ulcer is that if you are mobile and able to walk by yourself, you have a very high chance of being curable.

A good hint as to whether you have a venous leg ulcer or not is whether you are being treated by compression bandages or compression stockings. These make arterial ulcers worse but make venous ulcers better in the very short term. Unfortunately, although compression bandages and compression stockings they can help “heal” a venous leg ulcer in the short term, they do not cure it as they do not cure the underlying vein problem.

There are two main causes for venous leg ulcers – the commonest is “hidden varicose veins” (also called superficial venous reflux or chronic venous insufficiency – CVI) and the other less common is due to deep vein problems.

The good news for people with leg ulcers is that “hidden varicose veins” are easy to diagnose with a duplex ultrasound scan and can be completely cured with local anaesthetic endovenous techniques. In the majority of people, curing these “hidden varicose veins” results in the leg ulcer being permanently cured.

Deep vein problems are much harder to treat as the deep veins can either be blocked or can have lost the valves causing deep vein reflux. Although some of these can be cured, not all can be. Fortunately, the vast majority of venous leg ulcers are due to “hidden varicose veins” and so are curable.