A sign is something everybody can detect, such as a rash or bloodshot eyes, while a symptom is something only the patient can feel and describe, such as pain or ringing in the ears.
In the majority of cases, there is no pain. Signs may include:
- Veins can be seen as twisted, swollen and lumpy (bulging); some people have described them as cords
- The veins are blue or dark purple
Some patients may also experience:
- The legs aching
- The legs feel heavy, especially after exercise or at night
- A minor injury to the affected area may result in longer bleeding than normal
- Lipodermatosclerosis – fat under the skin just above the ankle can become hard, resulting in the the skin shrinking
- Swollen ankles
- Telangiectasia in the affected leg (spider veins)
- There may be a shiny skin discoloration near the varicose veins, usually brownish or blue in color
- Venous eczema (stasis dermatitis) – the skin at the affected area is red, dry and itchy
- When suddenly standing up, some patients may experience leg cramps
- A high percentage of people with varicose veins also have restless legs syndrome
- Atrophie blanche – irregular whitish patches that look like scars appear at the ankles.
Varicose veins can appear in various parts of the body, including:
- Legs (most common)
- Uterus (womb)
The main cause of venous leg ulcers is faulty valves inside the leg veins. These valves normally allow the blood to flow up the leg towards the heart, and prevent backward flow down the leg. If the valves are faulty, backward flow is not prevented and pressure builds up inside the veins. The persistent high pressure in the leg veins, caused by the faulty valves, damages tiny blood vessels in the skin. The skin will become dry, itchy and then inflamed. Due to the poor blood supply it doesn’t heal well, and can easily break down to leave an open sore after minimal trauma. This is how the ulcer forms.
Some people are born with weak valves. In others, the valves are damaged after a venous thrombosis (a blood clot forming within a vein). Valves tend to weaken with age.
Are venous leg ulcers hereditary?
Venous leg ulcers are not hereditary; however, some of the things that put you at risk of developing a venous leg ulcer do fun in families – such as poor valves or a tendency to have a blood clot.
What does a venous ulcer look like and what are its symptoms?
Before the ulcer appears, you may notice your leg swelling and you may find it painful to stand for long periods. Brown spots and patches may appear on the skin, and the altered blood flow can turn the skin various shades between red and blue. Your skin may become itchy and scaly, and firm tender areas may develop under it.
The ulcer itself is an open sore. The bed of the ulcer may show bumpy, moist and red healing tissue, or may be covered in a yellowish-grey layer. Ulcers often leak fluid, the amount of which can vary.
A venous ulcer can be painful, although the pain is usually relieved when the pressure is controlled by raising the leg or by wearing compression (tight and stretchy) bandages or stockings. Some patients find that it is painful during dressing changes when their ulcer is exposed to the air. However, if your ulcer gives you severe pain, this may mean that it has other causes, such as blockages in the arteries, and you should tell your doctor.
How will a venous ulcer be diagnosed?
The changes seen in your skin will indicate to your doctor that you have a venous leg ulcer. However, it is important to check for other possible causes, especially a poor arterial circulation. To do this, the doctor or nurse will feel for the pulses in your foot and may measure the blood pressure in your leg with a small ultrasound probe (“Doppler”). Occasionally other tests are needed, such as removing a small piece of skin for microscopic examination (a biopsy), blood tests, or more specialised investigation of the circulation in an X-ray department.
Can a venous leg ulcer be cured?
If it is simply a venous ulcer, yes. But if other conditions such as diseased arteries are contributing to the ulcer, it may be more difficult.