Picture of a leg ulcer on the back of a patients calf

Ulcers are painful and unsightly blemishes on the skin. The appearance of ulcers should be a cause for alarm as they do not easily heal on their own and can lead to more serious illnesses like infections. Ulcers are caused by the breakdown of the skin cells. Long-standing venous stasis which goes undertreated is a common reason for ulcers in the legs. Sores like this can be so painful that they can seriously affect your quality of life. At the Advanced Vein Center, our goal is to prevent these potentially disabling ulcers from forming. If you already have leg ulcers, there are a number of vein treatments available to treat them and get you back on the road to a healthy life.

Leg Ulcer Symptoms

Venous ulcers are both painful and unsightly. Undertreated 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. 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?

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 to moderate discomfort.

Diagnosing Lower Leg and Ankle Ulcers

In nearly all cases, no specialized testing is needed to diagnose an ulcer. The physician uses signs and symptoms to reach his or her conclusion.

Medical imaging such as a 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.

The majority of insurance companies require an ultrasound study to establish “medical necessity” before approving coverage for various procedures. Most vein procedures for symptomatic varicose veins are covered by insurance.

Treating Visible Varicose Veins that Contribute to Leg Ulcers

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.

Wound Treatment – The dermaPACE Breakthrough

The dermaPACE is new medical device for wound care. It is FDA approved (U.S. Food and Drug Administration) for treating venous stasis ulcers and diabetic foot ulcers. It uses sonic shock waves to stimulate healing in a variety of different types of wounds. Additionally, the dermaPACE device is approved by many international regulators to treat chronic and acute conditions of the skin and subcutaneous soft tissues (the tissue under the skin).

The body’s physiological responses to the application of shock wave treatment has been researched for over 3 decades. Its safety and efficacy has been well documented over those 30 years. However, several of the most clinically relevant developments regarding tissue regeneration were discovered recently. Peer-reviewed, scientific studies examining medical shock wave therapy is thoroughly documented. The results paint a strong picture of the potential benefits that PACE based treatments can offer those suffering from painful wounds.

SANUWAVE Mechanism of Action

Medical innovators originally designed Shockwave treatment to treat kidney stones back in the 1990’s. Over the next three decades, researchers and practitioners have collected a wealth of data and medical experience in the realm of Shockwave therapies. These practical lessons have been combined with advancements in engineering to produce an advanced medical tool. The state-of-the-art dermaPACE device represents the gold standard in Shockwave technologies. Optimizing quality, efficacy and safety were at the heart of the development process. The dermaPACE has undergone comprehensive clinical studies and rigorous testing to confirm its safety and efficiency.

Research conducted using Doppler imaging to measure blood flow in treatment areas have demonstrated a marked increase in blood perfusion and vessel density 24 hours after treatment. This finding is valuable because it decreases the chances of ischemia (lack of blood flow) that is so often associated with inadequate healing. It is important to note that studies have shown that patients who have undergone PACE intervention did not experience any negative vascular side effects such as an unsafe change in blood pressure. 

Breaking Down Biofilm

Have you ever heard of biofilm? No it’s not a biographical movie, it’s an ultrathin, protective layer that entrenched bacterial colonies will sometimes produce. Just like our autoimmune system will defend our bodies from harmful pathogens, bacteria use the biofilm to keep out antibiotics. It creates a physical defensive barrier to protect the colony against antibiotic treatment. Shock wave therapies, like PACE, have been proven to break down the biofilm barrier, allowing antibiotics to penetrate to the bacteria and eradicate the colony.

Inflammation Response

Treatment of an ulcer on the outside of the foot.

Just as with many biological processes, there are several different pathways and stages of wound healing. One of them is the inflammatory, or swelling, stage. There is a misconception that swelling is bad and should be avoided. Swelling is a necessary step in the healing process. PACE treatment will trigger an immediate inflammatory response. You might be asking yourself, “how does that help?” Well, swelling signals the body to initiate certain actions to repair any damage in the area. 

Researchers at highly respected research hospitals have discovered that PACE treatments lead to an increase of white blood cells that pass through the vessel wall, moving into the treated tissues. The leukocytes in white blood cells are central to the healing process. Increasing their flow during the inflammatory phase of wound healing triggers the release of compounds that cause the growth of new blood vessels (pro-angiogenic). Researchers have demonstrated that pro-angiogenic factors have a profound impact on healing. Shock wave treatment causes the wound to move quickly through the inflammatory phase into the proliferation (cell duplication) phase of healing.

PACE Treatment FAQ

You should arrive early to the treatment center, especially if this is your first treatment.

Wear comfortable, loose-fitting clothing. Depending on the location of the injury, and the preference of your healthcare provider, you may be asked to put on a hospital gown. The staff will quickly check your vitals (temperature, pulse and blood pressure) and ask you a few questions about your general health.

Your physician may touch around the area to determine the ideal target spot. This is the area of maximum tenderness. He or she will mark the area with a surgical marking pen. If necessary, some imaging scans may be taken. This can include an ultrasound, an x-ray, or others. It is possible that the procedure may cause some minor discomfort or pain. To avoid this, local anesthesia may be administered.

A conductive gel will be applied to the skin over the target area (the area previously marked with the surgical marking pen). This high viscosity gel will promote the transference of shockwave from the instrument to the tissue. This will enhance the effectiveness of the treatment.

After the procedure, you will need to stay at the clinic for observation until the anesthesia wears off. Once you can safely move around, you will be permitted to leave.

The staff will cover post-operative instructions from your physician. It is a good idea to get these in writing because following them to the best of your ability is important for a full and speedy recovery.

The use of PACE is a non-invasive procedure and presents minimal risks.

In rare instances, it may lead to temporary red skin, bruising, numbness or tingling. There may be a temporary increase in pain immediately after the procedure. Some individuals report that the pain returns after the procedure. This pain may be constant or the episodes may come and go. This can persist for a few days to several weeks. It is also typical to experience some discomfort after engaging in intense exercise. These side effects are generally mild and go away on their own after a few days. If they do not, contact your healthcare professional.

Platelet Rich Plasma for Wound Care

The body is a living, breathing system that’s designed to self-regulate and keep itself in good working order. Modern medical science offers many seemingly miraculous Wound Care treatments, but it’s ultimately the body which must heal itself.

Platelet Rich Plasma (PRP) therapy is a newer medical therapy which triggers a powerful healing response in injured tissue. This makes it incredibly useful for a wide variety of wound care and chronic musculoskeletal conditions. Stubborn joint and back problems years in the making often respond well. It can also be effective at speeding up the healing of newer (acute) injuries and ulcerations.

Regenerative Medicine treatments such as PRP can be used to effectively treat both acute wound and chronic injuries. This includes treatment-resistant conditions like the back pain, achilles tendonitis, rotator cuff injuries, chronically sprained ankles, and plantar fasciitis. Our current understanding of the nature of chronic injuries and wounds at the cellular level is expanding rapidly. As this continues to happen regenerative treatments such as PRP are expected to play a much larger role in wound care and musculoskeletal medicine.