Recurring Leg Ulcers May Point to a Blood Vessel Problem

When ointment doesn't work, the problem may lie deeper

Many patients with recurring leg ulcers first treat them like ordinary wounds—ointments and dressings. The surface seems to improve, but before long the skin breaks down again in the same place or nearby. This recurring pattern usually means the underlying cause has not been addressed. The problem often lies not in the skin itself, but in the circulation beneath it.

Venous ulcers: the most common chronic leg ulcer

Venous ulcers typically appear on the inner lower leg just above the ankle. The surrounding skin is often discolored brownish and swollen, the wound edges are irregular, and there is often considerable drainage but relatively mild pain. They result from varicose veins or poorly functioning vein valves, which cause blood to pool in the lower leg. Persistently high venous pressure leaves the skin oxygen-starved and fragile, so it breaks down easily and heals slowly.

Arterial ulcers: painful, often on the toes or heel

Arterial ulcers are linked to poor peripheral arterial circulation and tend to occur at the tips of the toes or the heel, where blood supply is most limited. They are typically quite painful (especially when the leg is raised or when lying flat at night), have well-defined edges, and the surrounding skin may be pale and cool, with weak or absent foot pulses. Without timely treatment, they can worsen faster than venous ulcers.

How to tell which type you have

Appearance alone is not always enough. A vascular ultrasound—assessing venous reflux and whether arterial flow is narrowed—provides an accurate diagnosis, which is the essential first step toward the right treatment. For venous ulcers, care includes addressing the underlying varicose veins; for arterial ulcers, the focus is on evaluating peripheral arterial blockage. The approaches are completely different.

What to do when ulcers keep returning

• Don't rely only on treating the wound surface—seek a vascular evaluation to find the cause
• Avoid guessing the ulcer type and using unsuitable home care (for example, arterial ulcers are not suited to high-pressure compression stockings)
• Keep a record of where and how often the ulcers recur to share at your evaluation