In today’s times leg wounds are commonly due to the following causes :
Venous Ulcers : Causes :
- Varicose Veins
- Deep Venous Thrombosis
- Signs of change due to venous disease : leg pain/swelling especially during evenings , sclerosis of the skin(LDS) , hyperpigmentation , ankle flare of veins
- Previous ulcer history or family history of varicose veins(50%)
- Previous fracture or other leg trauma
Arterial ulcers (Gangrene) : Causes :
- Ischaemic Heart disease
- Peripheral Arterial disease
Any two or more causes in combination
Venous ulcers are commonly below mid calf to around the malleoli. They are shallow and can be painful with a burning sensation and will commonly have fluid coming out of them.
Arterial ulcers may occur in any area, however commonly at tips of toes and dorsum of foot. They are extremely painful and are comparatively dry as compared to venous ulcers. Pain is severe at night and while lying down and some relief can be got by dangling the legs…which is what most patients do. They are unlikely to be able to sleep at night.
Mixed ulcers may have a combination of these symptoms.
Neurotrophic or Pressure ulcers occur in the pressure bearing areas, especially tips of toes, ball of foot , heel, sacral area in bedridden patients. They will not heal till the pressure is relieved.