An ulcer is an open sore or lesion on the body that is slow to heal or keeps returning. An ulcer is caused by a breakdown of the skin tissue. There are three different types of ulcers—venous stasis, neurotrophic, and arterial ulcers. Of the three, venous stasis is the most common, 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? Who is at Risk?
Venous stasis ulcers are typically caused by a condition called venous hypertension. The blood does not flow from the lower legs back up to the heart as it should and, as a result, causes a build up 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 leg, just above the ankle.
Exactly how venous hypertension causes the ulcers is not fully known, but many doctors believe it also causes a decrease in blood flow to the capillaries of the leg, which, in turn, causes a build up of white blood cells. This accumulation of white blood cells causes a loss of oxygen to the tissue, which damages them, forming 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.
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 is possible you will develop them as well. Smoking is also believed to raise your risk of developing ankle ulcers as it interferes with the flow of oxygen through the bloodstream.
What are the Symptoms of Ankle Ulcers? How are They Diagnosed?
Venous stasis ulcers are not always painful, but they might burn a little or itch. They are usually red, with yellowish skin over them. If infected, the ulcer may leak fluid that is yellow or green. 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 very tight, and have a shiny appearance.
In order to diagnose the problem, your doctor will begin by asking you about your medical history and symptoms. Make sure to keep a record of all the symptoms you are experiencing because it will help your doctor reach the proper diagnosis. If you’ve had the ulcer for a long time, your doctor may want to take a tissue sample for a biopsy to make sure there is no cancer. The use of scans such as MRIs, CT scans, and radiography are also commonly used to check the depth of the ulcer and see if the bone is affected. Your ulcer will also be checked for infection.
What is the Best Treatment?
The primary goal of venous stasis ulcer treatment is to heal the wound, treat any infection present, and relieve any pain the ulcer is causing. Venous stasis ankle ulcers are usually treated with compression therapy to help with the swelling. Compression helps speed the healing process and also aids in the prevention of repeated ulcers. This may be accomplished with the use of compression stockings, compression wraps, or even an elastic bandage (like an ACE Bandage) wrapped around the leg up to the knee. You and your doctor can determine what compression method will work best for you and your type of ulcer.
If you have another condition that makes compression treatment a problem, your doctor may prescribe medications like pentoxifylline and aspirin. These medications have been shown to be very successful in treating ulcers. If you have significant swelling, you may need to take diuretics for a short amount of time.
In order to make sure that your ulcer heals properly it is important that you take all prescribed medication as directed, keep the ulcer area clean, and change the dressing on the ulcer as instructed. 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 dressing is best for your condition.
And always drink plenty of fluids, eat a healthy diet, and get adequate rest and exercise. Good overall health will speed your healing process.
Can Ankle Ulcers Be Prevented?
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 a day. This helps to reduce the pressure and swelling that can cause venous stasis ulcers, as well as help aid in blood circulation that may be impaired by venous hypertension.
If at all possible, you should try to elevate your legs in bed at night. Also, try to limit the sodium (salt) in your diet and check your blood pressure regularly for any changes. If you are overweight, losing a few pounds can relieve some of the pressure on your legs, which can lower your risk that ankle or leg ulcers will ever be a problem for you.