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Q: I'm looking for information on venous stasis ulcers. Thanks.

-- M.O.

A: Venous stasis ulcers are skin-surface sores or ulcerations caused by reduced flow of blood in the deep veins of the leg.

The problem typically begins with as accumulation of excess fluid (called edema) under the skin in the affected area. Over time, the skin becomes red and scaly. Then the pigment of the skin darkens, and the skin tissue begins to break down and ulcerate.

Symptoms that occur with this process include early itching, dull discomfort made worse by standing, and eventually pain when ulceration begins.

Lower leg ulceration is usually seen in people with problems of the deep veins returning blood from the legs back to the heart. Blood clots, leg injury and prolonged inactivity or immobility are associated with venous insufficiency.

In this condition, the valves in the deep veins have been damaged and the pumping action of the muscles around the veins has been reduced, resulting in an inadequate return. This reduced functioning results in an accumulation of fluid in the area that initiates the process of ulceration.

Ulceration caused by venous insufficiency is almost always restricted to the calf, between the knee and ankle. If ulceration is seen in the feet and toes, or above the knee, it's probably due to another disorder, such as diabetes.

Venous insufficiency is the most common, but not the only, cause of lower leg ulceration. Congestive heart failure or chronic renal disease can also result in this same problem. However, both legs are usually affected with these diseases.

There is a lot an individual can do to control, prevent and treat lower leg ulceration when it is caused by venous stasis. Prevention involves control of edema to prevent recurrence of the ulcers.

The affected leg should be elevated above the heart at night and periodically during the day. Sitting or standing for long periods of time should be avoided. Compression stockings are often helpful.

Anticoagulants, sometimes called blood "thinners," are often recommended to reduce formation of blood clots and minimize valve damage.

Conventional treatment of this condition begins with thorough cleaning of the ulcerated areas, followed by topical application of metronidazole, an antibacterial. Skin inflammation may be treated with a steroid ointment.

The ulcerated area is then covered with a special series of dressings that are changed weekly. That may include a device known as an Unna's boot, which is a cast-like boot filled with a paste containing zinc. The boot protects the skin from injury and irritation, and the paste helps with healing.

Ulcers treated in this way should begin to heal within weeks of treatment, and completely heal in a few months. More serious ulcerations may require skin grafting.

A recently reported study suggests a new treatment for chronic venous stasis ulcers in people for whom conventional therapy didn't work. With this procedure, a non-contact radiant heat bandage is placed over the ulcerated area for five hours daily for two weeks. Wound size, status and pain severity all improved with this inpatient therapy.

Update on cardiovascular disease: Medical studies are continuing to report results that homocysteine (an amino acid) is a major factor in causing disease of the coronary arteries of the heart.

Damage to the coronary arteries is called arteriosclerosis and causes heart malfunctions such as arrhythmias, heart attacks and heart failure.

Seven separate studies were reported in a recent issue of the Annals of Internal Medicine exploring what is known about the connection between homocysteine, cardiovascular risk and vitamins.

These studies indicate that high levels of homocysteine do increase the risk of heart problems, especially if a person has other risk factors such as a family history of heart disease, high blood pressure, high cholesterol and a sedentary lifestyle.

In addition, evidence shows that taking folic acid (one of the B vitamins) will lower homocysteine levels and therefore should decrease cardiovascular risk.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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