What sort of leg ulcer do I have?

It is impossible to have a 100% accurate self-diagnosis tool and so the outline below should only be used for guidance. However it should help you make sure that you are asking the right questions and for the right investigations and treatment.

As the charity progresses and we received donations allowing us to develop and research the pathways easier, we will modify this and make it more useful for patients and carers in the future.

1 – Can you walk well?

Most leg ulcers require the circulation in the leg to be as good as possible. As such it is always much harder to treat people who are immobile and not able to walk.

2 – Where is the leg ulcer?

Most curable venous leg ulcers are in the lower leg either around the ankle bones or between the ankle and the calf. They are usually on the inner side of the lower leg but can sometimes be on the outer side of the lower leg or even wrap around the lower leg.
Ulcers that are on the foot or toes, particularly if small, are more likely to be arterial.

3 – What happens when I put my leg up?

A venous leg ulcer usually improves when the leg is elevated. Also, on elevation the toes should stay pink if the arteries are working well and the problem is the veins.

The venous leg ulcer improves because gravity stops the blood from refluxing down the “hidden varicose veins”. As such the inflammation caused by this venous reflux ceases, and so any discomfort eases and the ulcer feels better. Before we had the new diagnostic tests such as duplex ultrasound scanning, a good test for venous leg ulcers was to put the patient in bed for two weeks with their legs elevated and not let them get out bed. If in that two weeks the ulcer started to heal, we knew it was a venous leg ulcer.

When we have a patient with severe leg ulcers, sometimes it is still necessary to put them to bed with elevated legs for one to 2 weeks to start the healing process before operating. However nowadays we are aware that the bed rest increases the risk of deep vein thrombosis (DVT) and so this should not be done unless the patient is given blood thinning injections to protect them.

If the toes or foot or the leg ulcer itself hurt more when the leg is elevated, and particularly if the pain is relieved by hanging the leg down, then an arterial leg ulcer is more likely. This is even more likely if the toes in the leg is elevated and deep red when the leg is hung down.

If going to bed causes such pain in the toes or foot or ulcer that it wakes patient up in the middle of the night and the pain is only improved by hanging the leg out of bed or getting up for a walk, then it is even more likely to be an arterial ulcer.

There are many other signs and symptoms that can help you diagnose your own ulcer and as the charity progresses and donations received, work will be done to improve this self diagnostic process.

However the above should cover at least 90% of people with leg ulcers and if you have already sorted out whether a leg ulcer is venous or arterial, you will want to know what to do next. This is covered in the next page – What should I do about my leg ulcer?