Lower Limb Ulcers Introduction
Lower limb ulcers are wounds on the lower leg (below the knee) and foot that are slow to heal. For this section, a wound on the leg is defined as a wound that originates on or above the ankle bone (malleolus).
Leg ulceration tends to occur due to problems with the circulatory system. For example, poor blood flow return via the venous system - venous leg ulcers, and insufficient blood reaching the lower limb because of peripheral arterial disease – arterial leg ulcer. There are also leg ulcerations that can be a combination of both conditions – mixed leg ulcers (NWCSP, 2020).
The biggest proportion of leg ulceration is venous leg ulcers (VLU), approximately 70%. Arterial leg ulcers occur in approximately 15 to 20% and a combination of mixed ulceration, venous and arterial, may occur in 10% to 20% of individuals (EWMA, 2017). Lower limb leg ulcers can be challenging as they tend to be chronic, recurrent and slow to heal.
In the UK it is estimated that 1.6% of the adult population is affected by an active ulceration (NWCSP, 2020). Lower limb ulcerations tend to be more common in the older population and higher among women than men.
The burden of wound care for the lower limb is expected to rise due to an ageing population and an increase in obesity. Data from Australia estimates the annual health care costs of venous leg ulcer treatment (VLU) is more than AUD$ 3 billion yearly, and in the UK at £941 million (Probst et al., 2021).
The impact on a person living with lower limb ulceration can be profound. It can be miserable due to pain, malodour and leakage, impaired mobility, anxiety, sleep disturbance and social isolation (NWCSP, 2020).
Appropriate treatment depends on the accurate diagnosis of the underlying aetiology, based on the patient’s medical history, clinical presentation of the ulceration and assessment procedures.
Incidence of leg ulceration
| Cause | Frequency of Occurrence |
|---|---|
| Venous | 70% |
| Arterial | 15-20% |
| Mixed Arterial/Venous | 10-20% |
| Others | 2-5% |
(Moffatt, 2001; Lim et al., 2021; EWMA, 2017) – please note percentages are approximate.
It is important to differentiate between venous and arterial disease and that of mixed arterial and venous origin ulcers to ensure the correct management is instigated.
This module will now cover venous ulcers in more detail, looking at causation through to treatment. It will then move on to look at arterial ulcers.