Leg Ulcer Symptoms
Venous ulcers are both painful and unsightly. Furthermore, untreated ulcers (or ulcers that aren’t treated correctly) almost always lead to more severe medical issues. This condition is a direct consequence of a long history of untreated vein disease of the thighs and lower legs. This underlying disease is known as Chronic Venous Insufficiency (CVI), also known as venous reflux.
These ulcers are almost always located on the inner ankle just behind the “large bump,” aka the medial malleolus. Most ulcers of this type occur adjacent to visible varicose or spider veins. Other vein-related skin changes such as discoloration and thickening of the skin are also commonly seen alongside ulcers.
Venous ulcers present as shallow, inflamed, reddish sores. When infected, which is a distinct risk for all non-healing wounds, they can take on a yellowish color. As mentioned, the worst thing about venous stasis ulcers is the fact that they heal slowly or not at all.
In many cases, venous ulcers have an adverse psychological impact. Non-healing wounds of all types can be extremely painful. They also commonly limit patient mobility and decrease quality of sleep. These are all well-documented risk factors for and potential causes of depression and anxiety.
What causes venous stasis ulcers?
As mentioned above the underlying cause of stasis ulcers is a vein disease called Chronic Venous Insufficiency (CVI). Among clinicians it’s more commonly referred to as venous reflux or simply “reflux.” Put simply, reflux is the backflow of blood in the large veins of the legs.
All veins have a series of valves which are designed to prevent blood from flowing down the legs. Over time, leg veins tend to stretch out until the flaps of these one-way valves no longer touch. This causes blood to reverse its course and travel away from the heart, eventually pooling in the legs.
CVI causes a host of problems, ankle ulcers being one of the most severe. More common symptoms include a heavy feeling in the legs, tiredness, and mild-moderate discomfort.
Diagnosing lower leg and ankle ulcers
In nearly all cases no specialized testing is needed to diagnose an ulcer (or venous reflux, for that matter. Instead, the physician uses signs and symptoms to reach his or her conclusion. This is known as a clinical diagnosis.
Yet with this being said medical imaging, particularly Doppler Ultrasound, is useful in determining the severity of a patient’s CVI. This versatile imaging technique can also be used to rule out potentially dangerous blood clots. Using ultrasound, a Registered Vascular Technologist (RVT) can also determine precisely which sections of a vein are affected.
Also note that the majority of insurance companies require an ultrasound study before approving the procedure. This is part of establishing “medical necessity,” without which medical insurance companies won’t cover the procedure. Most vein procedures for symptomaric varicose veins are covered.
Treating visible varicose veins.
Several simple, effective procedures are currently being used to treat venous reflux. This resolves many symptoms such as achiness, tiredness, and a feeling of heaviness. These treatments aren’t perfect, however, and can fail to resolve visible, ropey varicose veins. In cases such as this it’s necessary to physically remove the defective vein.
While this might sound ominous it’s precisely what’s needed. Once these defective veins are removed blood is instantly rerouted to nearby healthy veins which improves overall circulation. This minor, minimally invasive procedure is called a microphlebectomy and actually improves a patient’s overall circulation.
As with most venous procedures a microphlebectomy is performed on an outpatient basis. This typically means either your doctor’s office or an outpatient surgery center. The procedure itself takes about an hour and requires only a local anesthetic such as lidocaine is needed.
To begin, ultrasound images are used to evaluate the vein in question (and establish medical necessity for insurance purposes). The area is numbed with lidocaine and the surgeon then makes tiny vertical incisions to access the diseased vein. At this point the vein is removed using specialized surgical tools. It’s important to note that a microphlebectomy is very minimally invasive. The access incisions are only millimeters long and usually don’t require stitches. Scarring is minimal to nonexistent.
After the procedure the area is wrapped tightly in sterile dressing. In the days following the procedure wearing compression stocking is necessary. it’s necessary for a patient to wear compression stocking in the days following the procedure. This reduces discomfort, swelling, bruising, and aids in healing. Recovery is very rapid, and most patients are able to return to work the same day if necessary. After about 2 weeks the patient can resume all activities, including strenuous exercise.