Venous Leg Ulcer: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate venous leg ulcer:

Leading symptoms

  • Ulceration (ulcer) on altered skin.
    • Hyperpigmentation
    • Eczema
    • Dermatosclerosis – hardened, atrophic skin.
    • Atrophy blanche – whitish discoloration of the skin; often painful.

Predilection sites (body regions where the disease occurs preferentially): onset above or behind the medial malleolus (inner ankle).

Therapy-resistant ulcerations occur frequently.

Comparison of ulcer types

Venous ulcer Arterial ulcer Diabetic/neuropathic ulcer
Ulcer Flat ulcer, often occupied, that is polycyclic limited “gaiter ulcer” (in insufficiency of the saphenous vein parva (VSP) and other veins): Ulcer occupies the entire circumference (circumference) of the lower leg. Necrotic ulcer, as if punched out. Circular, as if punched out, partly urgent in depth, partly also superinfected
Localization Above or behind medial malleolus (inner malleolus)(medial malleolar (inner) > lateral malleolus (lateral)) Arterial end-stream areas: Toe tips and interspaces Pressure points; altered foot architecture (due to progressive descent of the metatarsalia (MT; metatarsal bones) in the forefoot), e.g., MT II and III distal
Ulcer environment Stasis purpura/stasis hemorrhage; lipodermatosclerosis nun (stasis fibrosis of the skin)varicosis (presence of varices (varicose veins)), peripheral edema (swelling), stasis dermatitis (stasis eczema) Shiny skin, also hair loss (tibial baldness/leg baldness). Partially pronounced surrounding callus formation (unless there is concomitant ischemia/reduced blood flow)
Pain Mild to moderate pain; elevation of leg improves pain Severe pain, especially with prolonged walking or elevation of the legNote: drooping the leg improves pain. Painless.
More hints S. a. peripheral arterial occlusive disease (pAVD) S. a. diabetic foot/diabetic polyneuropathy

Warning signs (red flags)

  • Malnutrition (especially protein deficiency)
  • Pain in the muscles → think of: peripheral arterial occlusive disease (pAVK).
  • Deep ulcers → think of: arterial component.
  • No healing after three months → refer to an angiologist (vascular disease physician).