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Ankle Ulcers

What are ankle ulcers?

An ulcer is an open sore or lesion on the body that is slow to heal or keeps returning. Ulcers result from skin tissue breaking down and may be painful. There are three different types of ulcers:

  • venous stasis
  • neurotrophic
  • arterial ulcers

According to the Cleveland Clinic, venous stasis is the most common type of ulcer and accounts for between 80 and 90 percent of ulcers affecting the lower legs. Venous stasis ulcers are the most common type of ankle ulcers.

What causes ankle ulcers?

Venous stasis ulcers are typically due to a condition called venous hypertension or chronic venous insufficiency. The blood doesn’t flow from the lower legs back up to the heart as it should, and causes a buildup of pressure in the veins. The additional pressure can lead to an ulceration on the skin. These ulcers usually form on the inside of the legs, just above the ankle.

It’s unknown exactly how venous hypertension causes the ulcers. Many doctors believe it also causes a decrease in blood flow to the capillaries of the legs. This produces a buildup of white blood cells. The accumulation of white blood cells restricts oxygen to the tissue, which damages it and forms the ulcer.

Another theory is that venous hypertension causes cells of the body to leak into the skin and influence cellular growth. This process interferes with the repair of damaged tissue.

Who is at risk for ankle ulcers?

You may have a higher risk of developing venous stasis ulcers if you have or had:

  • previous leg swelling
  • history of blood clots
  • varicose veins
  • history of inflammatory diseases

If you have a family history of ulcers, it’s possible you will develop them as well. Smoking may raise your risk of developing ankle ulcers because it interferes with the flow of oxygen through the bloodstream.

What are the symptoms of ankle ulcers?

Venous stasis ulcers aren’t always painful, but they might slightly burn or itch. They’re usually red, with yellowish skin over them. An infected ulcer may leak yellow or green fluid. The skin may feel warm or hot to the touch, and the area surrounding the ulcer may be swollen and discolored. Your legs may ache, and, depending on how swollen your ankle is, the skin may feel tight and have a shiny appearance.

How are ankle ulcers diagnosed?

Your doctor will begin by asking you about your medical history and symptoms. Make sure to keep a record of all your symptoms because it will help your doctor make a diagnosis.

If you’ve had the ulcer for a long time, your doctor may want to take a tissue sample to make sure there’s no cancer. MRIs, CT scans, and radiography can also check the depth of the ulcer and if it’s affected bone. Your doctor will also check your ulcer for infection.

What are the treatments for ankle ulcers?

The primary goal of venous stasis ulcer treatment is to heal the wound, treat any infection, and relieve pain. Compression therapy to help with swelling is the usual treatment for venous stasis ankle ulcers. Compression helps speed the healing process and also aids in the prevention of repeated ulcers.

Compression stockings, wraps, or even an elastic bandage wrapped around the leg up to the knee can help. You and your doctor can determine the compression method that will work best for you and your type of ulcer.

Your doctor may prescribe medications such as pentoxifylline and aspirin if compression treatment isn’t effective. These medications can be successful in treating ulcers. You may need to take diuretics for a short time if you have significant swelling.

It’s important that you take all prescribed medication as directed. Keep the ulcer area clean and change the dressing on the ulcer as instructed to encourage healing. There are several types of dressings you might use for an ulcer, including antimicrobial, collagen, composite, and skin substitute dressings. Your doctor can explain the advantages of each type and advise you on which is best for you. They may even refer you to a wound clinic that specializes in treatment of wounds.

Always drink plenty of fluids, eat a healthy diet, and get adequate rest and exercise. Good overall health will speed your healing process.

How can I prevent ankle ulcers?

One way to prevent the development of venous stasis ulcers is to elevate your legs above your heart for at least 30 minutes, several times per day. Limit prolonged standing or sitting. This helps reduce the pressure and swelling that can cause venous stasis ulcers and will help aid in blood circulation.

Try to elevate your legs in bed at night if possible. Also, try to limit salt in your diet and check your blood pressure regularly for any changes.

Sometimes losing weight can relieve some of the pressure on your legs. Check with your doctor to see if they believe weight loss is appropriate for you.

Content licensed from:

Written by: Carmella Wint and Matthew Solan
Medically reviewed on: Nov 23, 2015: William A Morrison, MD

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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