GPAtlas🧭 When to suspect
Suspect a venous leg ulcer in an open lesion below the knee that has not healed within 2 weeks, typically in the gaiter area (between calf and ankle, classically over the medial malleolus). Venous disease accounts for the majority of leg ulcers and arises from chronic venous insufficiency → sustained venous hypertension → progressive skin breakdown.
The patient usually has a background of varicose veins, previous DVT or leg oedema, and describes an aching, heavy leg that is relieved by elevation. Surrounding skin shows the stigmata of venous hypertension – haemosiderin staining, varicose (venous) eczema, and lipodermatosclerosis (the hardened, "inverted champagne bottle" lower leg).
Two clinical skills matter most: confirm the ulcer is venous and exclude arterial disease (by pattern recognition and a measured ABPI), and treat the underlying venous cause, not just the wound. Most ulcers are colonised but not infected, and antibiotics do not promote healing of an uninfected ulcer.
| Venous ulcer | Arterial ulcer | Neuropathic ulcer |
|---|---|---|
|
• Site: gaiter area, medial malleolus • Look: shallow, irregular, sloughy/granulating, exudative • Pain: aching/heavy, eased by elevation • Skin: haemosiderin, venous eczema, lipodermatosclerosis, oedema |
• Site: toes, heel, lateral malleolus, pressure points • Look: "punched-out", deep, dry, pale/necrotic base • Pain: severe, worse on elevation and at night • Skin: cold, shiny, hairless; pulses reduced/absent |
• Site: sole, under metatarsal heads, pressure points • Look: deep, surrounded by callus; may probe to bone • Pain: often painless (neuropathy) • Skin: warm, dry; pulses usually intact; often diabetic |
Risk factors strengthening suspicion: a previous leg ulcer (the strongest predictor of recurrence), varicose veins, prior DVT or phlebitis, obesity, immobility, increasing age, and comorbidities such as diabetes or peripheral arterial disease (which raise the chance of a mixed or arterial ulcer).
Source: NWCSP · NICE NG152
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.