Open leg

Introduction

The so-called open leg, also known as leg ulcer, is one of the greatest challenges in medicine with almost one million affected patients and sometimes very protracted courses of disease. Due to its relatively frequent occurrence and the complex treatment, the open leg is also a cost factor for health insurance companies that should not be underestimated. Since it is predominantly older patients with many other pre-existing conditions (multimorbid patients) who have to struggle with it, it is not expected to stagnate but rather to increase the number of cases in the near future.

Cause

Ulcus cruris is often based on a venous disease as the preceding underlying cause. However, it can also be triggered by diseases of the arteries or by a combination of both factors. In rare cases, open legs can also have other causes.

These include infections that heal poorly and/or are incorrectly treated, some blood diseases, joint damage and also, for example, cancer of the affected tissue. In general, however, the cause lies within the blood-supplying system, as described above. Due to the disorder in the vascular system, the tissue on the leg is undersupplied or the outflow is disturbed, resulting in a build-up of blood.

In the most common case (about 80% of cases), the cause is a weakness of the veins, which means that used blood from the legs is no longer pumped back to the heart effectively enough. Blood congestion initially causes edema (swelling of the leg due to increased water retention) in the area of the lower leg. This leads to hardening and over-tensioning of the skin and underlying tissue.

This congestion slows down the blood flow in the leg or even stops it completely. Without the blood flow as a transport system, the tissue lacks important nutrients and especially oxygen. Waste products accumulate.

This last step can also be observed in an arterially conditioned open leg; in this case, the arteries themselves, due to the changes they have undergone during the course of a disease, which makes them calcify and narrow, hinder the adequate supply of the legs and feet with sufficient oxygenated blood. These topics may also be of interest to you:

  • Arteriosclerosis
  • Chronic venous insufficiency

Diabetes mellitus is an extreme risk factor for an arterially caused open leg. Like high blood pressure, smoking and greatly increased blood lipid values (hyperlipidemia), it promotes arteriosclerotic processes that permanently damage the arteries.

In addition, diabetes mellitus leads to a reduction of pain and pressure sensations in the foot area (diabetic polyneuropathy). Undetected minor injuries can then, in combination with a corresponding circulatory disorder, become protracted open wounds. It is therefore important that diabetics themselves regularly examine their feet and legs and look for skin changes and other signs of a circulatory disorder.

Finally, the increased sugar content in the tissue of the entire body caused by diabetes mellitus also promotes the development of a leg ulcer, since bacteria can multiply much better and faster in a sugary environment after entering the body. A thrombosis is a blood clot that gets stuck in a vessel and clogs it. If this happens in a vein, the blood can no longer be transported away and fluid accumulates. Similar to vein weakness, tissue damage occurs, resulting in open spots on the leg. Typically, thrombosis also leads to overheating of the affected leg, which indicates inflammatory processes.