Why does an ulcer appear and what is it like?
The most common cause is chronic venous insufficiency. Due to incompetent valves, blood stagnates in the veins of the lower leg, the pressure in them increases, fluid and blood cells leak into the tissues. The skin over the ankle darkens, thickens, and after a minor injury or scratching an ulcer forms. With atherosclerosis of the arteries of the legs, the tissues, on the contrary, do not receive enough blood, and ulcers appear on the fingers and feet. In diabetes mellitus, damage to nerves and blood vessels is combined: the person does not feel the injury, and the wound imperceptibly deepens.
- Venous - most often on the inner surface of the lower third of the leg
- Arterial - on the toes, heel, dorsum of the foot, very painful
- Diabetic - in places of pressure on the sole, often painless
- Mixed - with a combination of venous and arterial pathology
- Rare causes: vasculitis, infections, oncological processes
Risk factors
The risk is increased by anything that disrupts blood flow or tissue nutrition. Previous deep vein thrombosis is one of the most common causes of severe venous insufficiency. Prolonged standing work, excess weight, inactivity, pregnancy and hereditary weakness of the venous wall contribute to varicose veins. Smoking, diabetes and high cholesterol accelerate arterial damage. Of particular importance are injuries and repeated erysipelas, each of which impairs lymphatic drainage and skin nutrition.
- Varicose veins and previous deep vein thrombosis
- Diabetes mellitus
- Atherosclerosis of the arteries of the lower extremities
- Smoking
- Obesity and inactivity
- Standing or sitting work
- Repeated erysipelas
What does a person look like and feel?
Long before the wound appears, the skin in the lower third of the leg changes: brown spots, areas of compaction, itching and peeling, swelling in the evening. Then a defect forms with uneven edges and a wet bottom. A venous ulcer is often moderately painful, and the pain decreases when the leg is elevated. An arterial ulcer is characterized by sharp pain, which intensifies in a horizontal position and is relieved by lowering the leg. A diabetic ulcer can be painless, and a person discovers it by chance when examining the foot.
- Darkening and thickening of the skin over the ankle
- Swelling of the lower leg, worsening in the evening
- Itching, peeling, weeping
- Wound with uneven edges, discharge
- Pain depending on leg position
- Unpleasant odor due to infection
Survey
The main task is to determine the cause and evaluate blood flow. The main method is duplex ultrasound examination of the veins and arteries of the legs, which shows the functioning of the valves, the consequences of thrombosis and the degree of narrowing of the arteries. The ankle-brachial index must be measured: at low values, compression therapy is contraindicated. They check glucose and glycated hemoglobin, a general blood test, and in case of purulent discharge, a culture is taken to determine sensitivity to antibiotics. If the ulcer takes a long time to heal and looks unusual, your doctor may order a biopsy of the edge of the wound.
- Duplex scanning of veins and arteries of the legs
- Ankle-brachial index measurement
- Blood glucose and glycated hemoglobin
- General blood test
- Culture of discharge for microflora with antibiogram
- Biopsy for atypical or long-term non-healing ulcers
Treatment and prevention of relapse
For venous ulcers, the basis of treatment is properly selected compression: a multi-layer bandage or special knitwear. This is the most effective remedy that accelerates healing. The wound is cleaned of dead tissue and covered with modern dressings that maintain a moist environment; The choice of dressing depends on the stage and amount of discharge. Antibiotics are prescribed only for signs of infection and not for routine wound colonization. At the same time, they treat the cause: perform interventions on the veins, restore blood flow in the arteries, and achieve the target sugar level. After healing, compression stockings are worn continuously.
- Compression therapy for venous ulcers and sufficient arterial blood flow
- Wound cleansing and modern dressings
- Antibiotics only for proven infection - as prescribed by a doctor
- Sclerotherapy, laser obliteration or phlebectomy
- Restoration of arterial blood flow during ischemia
- Sugar control and foot relief in diabetes
- Constantly wearing knitwear and skin care after healing
