Venous Ulcers

The ulcers tend to form as a result of impaired oxygenation of the tissues, they develop over time, and movement of the limb is impaired, which is disabling. Pain and swelling occur on prolonged walking and standing and the skin above the medial malleolus (inner lower leg, above the ankle) is the most vulnerable to ulceration. The prevalence of venous ulcers is around 0.5% to 1%.

“It occurs in up to 50% of post-phlebitic legs after 5 to 10 years”. (Medical Discussion Paper, October 2004, - The Venous System – Robert Maggisano and AW Harrison, University of Toronto).

Post- thrombotic problems and venous ulcers respond favourably to expert bandaging, graded compression stockings (the pressure applied being greatest at the ankle and progressively decreasing) and walking (mobilisation). The ulcers usually heal when the venous return improves as a result of the compression bandages, but must be kept meticulously clean; antibiotics and skin grafting may be necessary in some cases. Once the ulcer heals, an elastic stocking worn daily ideally should prevent a recurrence.

Disabling Effects

When the cause of venous ulcers is incompetence of superficial and perforator veins only, there are excellent long-term results where up to 90% of venous ulcers heal completely after surgical treatment. However, if the deep veins are incompetent, there could be a high rate of recurring problems.

In severe cases, mobility may be affected, both in and outdoors, also the ability to get in and out of a chair, on and off the toilet, in and out of bed and up and down stairs. The person may have difficulty getting food in and out of an oven.

However, review in these cases would be important.

There would normally be no supervisory needs, or difficulty with functions that depend on upper limb use (unless an upper limb is affected, which is rare).

Amended April 2008