A leg ulcer occurs when there is a loss of skin cover that lasts for longer than is normal.
What is the scale of the problem?
Leg ulcers are an increasing problem in New Zealand, affecting about 1.5% of the population. Much of the increase in ulcers is related to our ageing population and increasing rates of diabetes and obesity. So, in New Zealand that is around 75,000 people. Managing leg ulcers is costly for society and the health system, as well as causing much discomfort and nuisance for affected patients.
What are the risks of a leg ulcer?
Venous ulcers, that is, ulcers caused by varicose veins or deep vein problems, like blood clots, are the most common cause of leg ulcers. Having peripheral artery disease increases the risk of developing an arterial leg or foot ulcer. The risk of diabetic foot ulcers increases in people who have had poorly controlled diabetes for a long period of time.
What are the types of leg ulcer?
There are two broad categories of ulcer – leg ulcers and foot ulcers. In general, venous ulcers usually affect the legs, artery ulcers can affect the legs or the feet, and diabetic ulcers usually affect the feet.
Venous ulcers
Venous ulcers are the most common ulcers. Blood pools in the legs from varicose veins or deep vein problems, leading to leg swelling, oedema, dermatitis, discolouration, skin thickening and ulcers. All of these combine to impair healing.
Arterial ulcers
Poor artery flow to the legs from blocked arteries caused by peripheral artery disease (PAD), or some other artery condition, can cause artery ulcers. An ulcer forms when the skin breaks down and there is not enough blood supply to allow healing.
Often venous and arterial ulcers occur at the same time.
Diabetic foot ulcers
Diabetes may attack the nerves to the feet, resulting in loss of feeling and loss of the protective system that helps prevent injury and infection. Repeated injury to the foot skin increases the risk of ulcers. Artery disease risk is higher in people with diabetes and this compounds the problem.
What can be done?
Treating an ulcer will involve a multidisciplinary team of community nurses, GPs, diabetes specialists, skin specialists, vascular specialists, orthopaedic and plastic surgeons, podiatrists and wound care specialists.
First up, vascular investigations assess the arteries and veins with an ultrasound scan. X-ray and MRI scans are good for assessment of any underlying bone and tissue issues.
Varicose veins, deep vein problems, and artery problems will need to be managed.
Other medical issues, such as diabetes, high blood pressure, high cholesterol and obesity will all need addressing as well. Smoking increases ulcer risk and patients will be encouraged to give up.
Ulcer dressings are a specialised area of wound care and there are many different dressing options available. Special shoes worn to relieve pressure may also help those with foot ulcers. Compression socks or stockings are a vital part of patient care, because they help relieve pressure and can reduce swelling.