Treatment - Venous leg ulcer

With appropriate treatment, most venous leg ulcers heal within 3 to 4 months.

Treatment should always be carried out by someone trained in compression therapy for leg ulcers. This will usually be a practice nurse.

Cleaning and dressing the ulcer

The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This provides the best conditions for the ulcer to heal.

A simple non-sticky dressing will be used to dress your ulcer. This usually needs to be changed once a week.

Compression bandage

Your nurse will apply a firm compression bandage over the affected leg. This is to improve vein function in your legs and treat swelling.

These bandages are designed to squeeze your legs. This encourages blood to flow upwards towards your heart.

There are different types of bandage or elastic stockings used to treat venous leg ulcers. These may come in 2, 3 or 4 different layers.

The application of a compression bandage is a skilled procedure. It should only be done by trained healthcare staff.

The bandage is usually changed once a week or twice a week at the beginning of treatment if the leg is very swollen.

When compression bandages are first applied to an ulcer, it may be painful.

Ideally, you should have paracetamol or an alternative painkiller prescribed by your GP.

The pain will lessen once the ulcer starts to heal. This can take up to 10 to 12 days.

Care of your compression bandage

It's important to wear your compression bandage exactly as instructed. If you have any problems, it's best to contact your GP or practice nurse instead of trying to remove it yourself.

The compression bandage may feel too tight and uncomfortable in bed at night. If it does, getting up for a short walk will usually help.

In rare circumstances you may need to cut the bandage off if:

• you get severe pain at the front of your ankle
• you get severe pain on the top of your foot or toes
• your toes become blue and swollen

Once you remove the bandage, make sure you keep your leg elevated. You should contact your GP or nurse as soon as possible.

Treating associated symptoms

Swelling in the legs and ankles

Venous leg ulcers are often accompanied by swelling of your feet and ankles (oedema). This swelling is caused by fluid. This can be controlled by compression bandages.

Keeping your leg elevated when sitting will also help ease swelling. You should ideally keep your toes above your hips when elevating your leg.

You should also keep as active as possible and aim to continue with your normal activities.

Regular exercise, such as a daily walk, will help reduce leg swelling.

Itchy skin

Some people with venous leg ulcers develop rashes with scaly and itchy skin. When applying your dressings the nurse specialist will use plenty of moisturiser in order to avoid this as much as possible.

This is often caused by varicose eczema. This can be treated with a moisturiser (emollient) and sometimes a mild corticosteroid cream or ointment.

In rare cases, you may need to be referred to a dermatologist (skin specialist) for treatment.

Itchy skin can also sometimes be caused by an allergic reaction to the dressings or creams applied by your nurse. If this happens, you may need to be tested for allergies.

It's important to avoid scratching your legs if they feel itchy. Scratching damages the skin and may lead to further ulcers.

Looking after yourself

To look after yourself during treatment:

• Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse.
• Whenever you're sitting or lying down, keep your affected leg elevated.
• Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation.
• If you're overweight, try to reduce your weight with a healthy diet and regular exercise.
• Stop smoking and moderate your alcohol consumption. This can help the ulcer heal faster.
• Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear.

Treating an infected ulcer

Sometimes an ulcer can become infected. It will produce a large amount of discharge and become more painful. There may also be redness around the ulcer.

Infections should be treated with an antibiotic.

Antibiotics will cure the infection. But antibiotics do not heal ulcers and should only be used in short courses to treat infected ulcers.

Follow-up

You should visit your nurse once a week to have your dressings and compression bandages changed. They'll also check the ulcer to see how well it's healing.

After the ulcer has healed

Once you have had a venous leg ulcer, another ulcer could develop within months or years.

The most effective method of preventing this is to wear compression stockings at all times when you're out of bed.

Your nurse will help you find a stocking that fits correctly and you can manage yourself.

Various accessories are available to help you put on compression stockings and take them off.