What should I do about my leg ulcer?
If you have read the previous page, “what sort of leg ulcer do I have?“, and you think you have either a venous or arterial leg ulcer, then you should find the following guide useful. Once again, this is only a guide and you will need to take advice on your own specific case from your own specialist doctor. However many people are not getting the advice and treatment they need and so this should help you make sure you are getting the right treatment and advice.
At the moment this guide is very simple but as the Leg Ulcer Charity grows and donations received, we will use some of our resources to make this guide is interactive and useful as possible based on research of patients using it.
1 – Are you able to walk easily?
If the patient is not able to walk easily, then many of the treatments for leg ulcers are even less effective or ineffective. If however the leg ulcer is very painful even at rest, there might be some advantage in trying to treat it may lead to remove the pain. However this would require individual assessment by a specialist doctor.
Provided the patient is able to walk easily than the following guide can be followed in most cases:
2 – Suspected arterial leg ulcer
If an arterial leg ulcer is suspected, then it is essential that the arteries are investigated to find out what treatment is optimal. A simple Doppler pressure test at the ankle is not sufficient. If such a test is performed, it is often inaccurate and frequently says the pressure is better than it actually is. In addition, it never says whether an ulcer is curable or not.
There are several ways that are acceptable to investigate the arteries in a patient with an arterial leg ulcer. Colour flow duplex ultrasound scan of the arteries is very useful as it not only shows the arteries and any narrowings and blockages, but can also be used for the veins. However it is often difficult to see the arteries deep in the pelvis and so some vascular surgeons do not favour this. Arteriogram (injecting contrast and taking x-rays) and MRI can both be used with relative accuracy to find narrowed or blocked vessels. No test for arteries is 100% accurate and many vascular surgeons favour having at least two different techniques to be certain.
Without at least one of these imaging techniques being performed by a specialist vascular surgeon, no patient should ever accept that they have an incurable arterial ulcer.
3 – Suspected venous leg ulcer
Most people with leg ulcers will have a venous leg ulcer and so should follow this advice.
The presence or absence of visible varicose veins is irrelevant. Many patients with arterial leg ulcers incidentally have visible varicose veins and many patients with venous leg ulcers have “hidden varicose veins” that cannot be seen on the surface.
A previous history of deep vein thrombosis (DVT) is interesting but irrelevant unless the patient has had a scan and damage to the deep veins has been proven. Most patients with previous deep vein thrombosis recover without any damage the deep veins and so telling patients they are incurable just because they have had a previous deep vein thrombosis is wrong.
In previous decades, a “venous flare” or little blue veins around the ankle was thought to indicate damage to the deep veins as was deep brown staining of the lower leg. In the past many doctors and nurses have erroneously told patients with these signs that they have incurable venous leg ulcers. This has now shown to be completely incorrect as most people with these signs actually have “hidden varicose veins” (also called superficial venous reflux or chronic venous incompetence) causing them which are of course completely curable.
As such – No patient should ever accept an opinion from a doctor or nurse as to whether their venous leg ulcer is curable or not unless they have had a colour flow duplex ultrasound scan performed in a specialist clinic or by a venous specialist.
If any patient is treated with compression bandaging or compression stockings and has not had a venous duplex ultrasound scan performed by a venous unit specialised in vein disease and diagnosis, then there is a very high chance that they are missing out on a chance of being given curative endovenous treatment. It is exactly this situation that the Leg Ulcer Charity is targeting first as this is both the simplest group of patients to cure but also the largest group of patients that are currently being mistreated and prevented from getting a cure.
A venous duplex ultrasound scan, when performed by a specialist vein unit, should be able to pick up deep vein problems as well. If the superficial veins are normal, in other words the duplex ultrasound scan has shown there are no “hidden varicose veins” then unless a clear diagnosis is made of another cause, the patient should either be referred or seek specialist investigations and opinions as to whether there is deep vein obstruction or deep-vein reflux.
As noted above, this advice should cover about 90% of people but can only be given in general terms. Individuals may vary and will need to seek medical advice on their own particular circumstances. However the principles as outlined above are clear and, if the patient has not had the appropriate investigations, they cannot be told with any honesty or accuracy that they are incurable and need only dressings and bandages.
As the Leg Ulcer Charity grows we aim to improve this guidance and make it more specific as donations allow us to do appropriate research.