Varicose Ulcer: Causes, Symptoms and Treatment Options

 1. What is a varicose ulcer?

●      A varicose ulcer (venous leg ulcer or venous stasis ulcer) is a slow-healing open sore, usually on the lower leg or near the ankle.

●      It is the most common type of chronic leg ulcer, accounting for roughly 70-80% of cases.

●      It develops from long-standing vein problems, mainly chronic venous insufficiency (CVI).

2. Causes

How it happens:

●      Valves inside leg veins fail, so blood flows backward and pools in the legs (venous reflux).

●      This raises pressure in the veins (venous hypertension).

●      Fluid and blood cells leak into the surrounding tissue, which damages the skin and breaks down the tissue, forming an ulcer.

Risk factors:

●      Varicose veins or a history of deep vein thrombosis (DVT)

●      Age above 50, and female gender (pregnancy, hormonal factors)

●      Obesity

●      Prolonged standing or sitting (e.g., teachers, drivers, desk jobs)

●      Family history of vein disease

●      Previous leg injury or surgery

●      Low physical activity and calf muscle weakness

3. Varicose ulcer symptoms

Early warning signs:

●      Swollen ankles, heavy, aching or tired legs

●      Itching or burning over the varicose veins

●      Skin discoloration (brown or dark patches) near the ankle, called hemosiderin staining

●      Hard, thickened skin (lipodermatosclerosis)

●      Eczema-like dry, flaky skin (venous eczema)

Ulcer features:

●      Shallow, irregular wound, usually on the inner ankle

●      Red or yellowish base, with fluid (exudate) oozing

●      Surrounding skin that is swollen, warm and discolored

●      Mild to moderate pain, which often eases when the leg is raised

Signs of infection (see a doctor urgently):

●      Increasing pain, redness or warmth

●      Foul-smelling or pus-like discharge

●      Fever, or a wound that grows bigger

4. Diagnosis

●      Physical examination of the leg and skin

●      Ankle-Brachial Pressure Index (ABPI): rules out arterial disease before compression is used

●      Duplex ultrasound: checks vein valves and blood flow

●      Wound swab if infection is suspected

●      Blood tests (diabetes, anemia, nutrition) as needed

5. Varicose ulcer treatment options

a) Compression therapy (the gold standard)

●      Multilayer bandages or compression stockings (commonly 30-40 mmHg for ulcers)

●      Improves venous return and speeds healing

●      Not safe if arterial disease is significant, so check ABPI first

b) Wound care

●      Clean the wound with saline or clean water

●      Remove dead tissue (debridement) if needed

●      Use moist wound-healing dressings: foam, hydrocolloid, alginate or silver dressings for infected wounds

●      Change dressings as advised (every 1-7 days depending on drainage)

●      Keep the surrounding skin moisturized

c) Medications

●      Antibiotics only if infection is confirmed

●      Pain relievers

●      Pentoxifylline or micronized purified flavonoid fraction (MPFF), which may help healing in some cases

●      Diuretics are not routinely recommended for venous ulcers

d) Procedures to fix the underlying vein problem

●      Endovenous laser or radiofrequency ablation

●      Sclerotherapy (foam injection)

●      Vein stripping or ligation (surgery)

●      Skin grafting for large, non-healing ulcers

Treating the faulty veins significantly lowers the chance that the ulcer comes back.

6. Self-care and lifestyle tips

●      Elevate your legs above heart level for 30 minutes, 3-4 times a day

●      Walk daily and do ankle and calf exercises

●      Maintain a healthy weight

●      Avoid prolonged standing or sitting

●      Wear compression stockings consistently

●      Eat a balanced diet with protein, vitamin C and zinc

●      Quit smoking

●      Protect the legs from cuts and bumps

7. Prevention of recurrence

●      Recurrence is common (up to 70% without proper follow-up)

●      Wear compression stockings long term

●      Treat varicose veins early

●      Go for regular follow-ups with a vascular specialist

8. When to see a doctor

●      Any leg sore that doesn’t heal within 2 weeks

●      Signs of infection

●      Sudden leg swelling or pain (possible DVT)

●      Diabetes or poor circulation along with leg wounds

Conclusion:

The unmatchable legacy of RJR stands strong for 5 GENERATIONS till date for over 150+ years. Our branches are spread all over the southern states of India, whilst our roots are fixed in the very own land of the ancient siddhars. Our chief, Dr.S.R.Jeyadurai, begun his awe inspiring journey as the founder of RJR HERBAL HOSPITAL by following the footsteps of his ancestors. The spark for RJR was started first by our honourable chairman's great grandfather, whose life has a radical link to RJR's motto- "To Build The Healthy Society".

He was a native of TAMILNADU, who worked as a physician for the Sri Lankan royals, administrators, and noble families around early 1850's. The Royals and noble families of Sri Lanka were impressed with his diagnostic techniques and treatments and sought-after him for their medical needs.

Even when he was reaching great heights in the traditional medicine practice, he had the irresistible passion to help and heal the people in need around him. So, he started to treat patients in need with equally excellent medications for lowest charge or on the cuff. Still, his true desire was always to make the medical treatments and concoctions available for all the people of his homeland- both poor and rich equally.