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Module 5.3: Lower Limb Ulcers
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Pathophysiology of Venous Leg Ulceration

Venous leg ulceration is characterised by:

  • Valves within the leg veins become damaged and are less able or completely unable to prevent back flow.
  • The calf muscle pump may not be strong enough to push the blood upwards.
  • Venous blood volume increases in the lower leg veins, which results in the pooling of blood.
  • The vein walls stretch and allow fluid, including proteins and red cells, to leak into the tissues.
  • The cells in the tissues become filled with fluid and they may swell and leak.
  • The lymphatic system is unable to cope with the extra volume of fluid (lymphoedema).
  • Venous congestion and hypertension mean that the nutrients do not get to the tissue and skin. This results in dry skin and often varicose eczema.
  • Fluid in the leg is at risk of infection (cellulitis), and the skin and tissue are at risk of trauma.

(Anderson, 2006)

Poor valve performance can be caused by:

  • Congenital or familial defect/disorder
  • Damage from a previous deep vein thrombosis (DVT)
  • Surgery
  • Pregnancy
  • Varicose veins
  • Injury
  • Mechanical defect due to a higher obstruction to venous return

(Newton, 2010)

Causes of calf muscle pump failure:

  • Paralysis
  • Immobility
  • Fixed ankle joint
  • Regular ‘chair sleeping’ combined with poor mobility canal so significantly impair venous return

(Morison et al., 2004; Newton, 2010)

Progression of venous insufficiency