Do you have venous stasis ulcers? A leg ulcer is a wound on the leg that doesn’t heal for several weeks, and venous stasis ulcers, also known as venous ulcers, are the most common type of leg ulcer. In fact, about 90 percent of leg ulcers are venous stasis ulcers.
Quick Answer: You may have a venous stasis ulcer if you have a shallow, slow-healing wound on the inner ankle or lower calf that has been open for more than two to four weeks, especially with ankle swelling, brown or purple skin staining, itching or hardened skin around it, and an ache that eases when you raise your leg. The only way to confirm it is a vascular evaluation: an ankle-brachial index to check the arteries and a venous duplex ultrasound to find the leaking veins that keep the wound from healing.
So, what causes venous stasis ulcers? There are several different things that can cause venous stasis ulcers. Venous insufficiency is a major cause because it allows blood to flow backward and pool in the veins in your legs. Ulcers can also be caused by venous hypertension and other circulatory problems. The increased pressure in the veins can cause damage to the tiny blood vessels in your skin. This makes the skin fragile and easy to damage. Varicose veins can cause venous ulcers, as blood leaks out of weakened veins into the surrounding tissue. Ulcers can also be caused by diabetes, kidney failure, infections, and inflammatory diseases, as well as certain medications. Obesity is another cause of venous stasis ulcers.
Venous ulcers are usually located on the ankle or calf. If you’re developing venous ulcers, you might experience leg swelling and cramping, a dull ache or feeling of heaviness in the leg, itching, and tingling, with red-colored skin. Sometimes, there are signs of pooling blood, like dark red, purple, and brown spots where the skin is hard. The borders of the ulcers can be unevenly shaped, and the skin surrounding them may be shiny and tight, as well as warm or even hot to the touch. Venous stasis ulcers are painful and red, but sometimes they’re covered with yellow, fibrous tissue. There is sometimes drainage and discharge, particularly in people with a history of varicose veins and leg swelling.
Treatment of venous stasis ulcers can vary. How these ulcers are treated depends on how severe the ulcers are and what’s causing them. For some patients, who have only mild signs of venous disease, venous ulcers are treated with local wound care. The skin infections associated with venous ulcers may be treated with antibiotics, and over-the-counter medication can help with the discomfort and inflammation. In some cases, your vein care specialist may perform a procedure called debridement, in which dead and damaged tissue is removed from the area around the ulcer. This allows the body to replace these damaged cells with healthy, new tissue and will help the wound to heal properly.
For patients who frequently experience venous ulcers, as well as those with uncomfortable or unsightly varicose veins, more permanent treatment options may be recommended. These treatments are used to eliminate diseased vein that is the source of the ulcers. When the damaged vein is either sealed or removed from the body, it can no longer affect the circulation, and new ulcers won’t form. Talk to your vein specialist about treatments that will prevent future ulcers and protect your skin from potential infections and slow-healing wounds. Options for permanent treatment include:
- Endovenous ablation: This is the most common method for treating varicose veins. Typically, radiofrequency ablation is used, performed under a local anesthetic. A vein specialist inserts a catheter into a vessel, directing heat towards the vein and closing them. Sometimes, the heat is replaced with medication, and that’s called chemical ablation.
- Ambulatory phlebectomy: During this multi-step process, a variety of examinations and diagnostic tools are used to determine which veins are problematic. The physician will also look for clots and deep veins to make sure of the right course of treatment. During the phlebectomy, the affected veins will be treated and outlined, after which the doctor will inject local anesthesia under the skin and remove the bulging veins, using small incisions.
Chronic venous stasis ulcers can be difficult and costly to treat, so it’s smart to learn how to prevent venous stasis ulcers. Improving your circulation can help. Your vein specialist may recommend wearing compression hose or elevating your legs. It may also help to take short walks or work other light physical activity into your daily schedule. Eating a nutritious diet and maintaining a healthy weight can help, as can avoiding smoking. Smoking can negatively impact your circulation as well as causing sores to heal more slowly. If you’re prone to ulcers, try not to injure your legs.
Whether you have venous stasis ulcers, varicose veins, or some other sign of vein disease, you can trust the quality of care you’ll receive at Premier Vein & Vascular Center. Our experienced and skilled team specializes in treating vein disease, not just to improve your comfort level but also to help you find long-term positive results. At our two clinics in the Houston and Cypress area, our board-certified doctors use the latest advances in vascular treatment to address the underlying cause of your symptoms. Contact us through our website or call [company-phone id=2] to schedule a free vein screening and consultation.
Meet your vein specialist
Dr. Syed Raza, MD
Vascular & Interventional Radiology · Founder, Premier Vein & Vascular Center
Fellowship-trained interventional radiologist certified by the American Board of Radiology and the Royal College of Radiologists (UK). Former Chief of Interventional Radiology at UTMB Galveston and Memorial Hermann Memorial City, with 15+ years treating varicose veins, venous reflux and peripheral arterial disease.
How to Tell If a Leg Wound Is a Venous Stasis Ulcer
Patients often come to us with a wound that started small, perhaps from bumping the shin on a car door or scratching an itchy patch, and simply never closed. That story is typical of a venous stasis ulcer. The injury is not the real cause; it is the trigger. The real cause is long-standing high pressure in the leg veins, which leaves the skin so starved of healthy circulation that it cannot repair even a minor break.
A few questions help sort out whether a wound is likely venous:
- Has it been open for more than two to four weeks despite basic care?
- Is it in the gaiter area, between the ankle bone and the lower calf, especially on the inner side?
- Do you have ankle swelling that is worse in the evening?
- Is the skin around it stained brown or purple, itchy, scaly or tight?
- Do you have varicose veins or a history of a blood clot in that leg?
- Does the leg feel better when you put it up?
Several yes answers point toward a venous ulcer. They do not rule out other causes, which is why testing matters before treatment begins.
Venous Stasis Ulcers vs. Other Types of Leg Wounds
Leg and foot wounds have several possible causes, and the treatments can differ sharply. Strong compression helps venous ulcers heal but can harm a leg with poor arterial blood flow. Pressure relief, not compression, is the priority for a pressure injury.
| Wound type | Where it usually appears | How it often looks and feels | Most important first step |
|---|---|---|---|
| Venous stasis ulcer | Inner ankle, lower calf | Shallow, irregular edges, moist; aching eased by elevation | Venous duplex ultrasound and compression after arterial check |
| Arterial ulcer | Toes, heel, outer ankle, shin | Round, punched-out, pale or dry; painful, worse with leg raised | Ankle-brachial index; restore blood flow |
| Diabetic foot ulcer | Sole, ball of the foot, toes | Callused rim; often little pain due to nerve damage | Offloading pressure, blood sugar control, foot specialist care |
| Pressure injury | Heels, ankles, bony points | Starts as discolored skin over bone | Relieve pressure and reposition |
| Mixed ulcer | Lower leg | Features of both venous and arterial disease | Careful testing before choosing compression strength |
Mixed ulcers are more common than many people realize, particularly in older adults and those who smoke or have diabetes. In those cases, we check the arteries closely and may treat peripheral arterial disease before using full-strength compression.
The Skin Changes That Come Before an Ulcer
Venous ulcers develop at the end of a long progression, and each step is visible on the skin. Recognizing these changes gives you a chance to act before a wound forms.
- Ankle flare: a fan of small dilated veins around the inner ankle or foot
- Pitting swelling: pressing a finger into the ankle leaves a dent
- Hemosiderin staining: rusty brown patches from iron in red blood cells that leaked into the skin
- Stasis dermatitis: red, itchy, flaky skin that can look like eczema and is sometimes mistaken for infection
- Lipodermatosclerosis: skin and fat above the ankle that become hard, tight and tender, sometimes giving the lower leg an inverted champagne-bottle shape
- Atrophie blanche: small white, scar-like areas that are especially prone to breaking down
If you see these changes, an ultrasound now can identify the leaking veins while the skin is still intact.
How We Evaluate a Suspected Venous Stasis Ulcer
At Premier Vein & Vascular Center, the aim of the first visit is to confirm what kind of wound it is, find the cause and make sure the treatment chosen is safe for your circulation.
- History and wound review. We ask how and when the wound started, what has been tried, your medical conditions such as diabetes, kidney or heart disease, prior blood clots, smoking and medications.
- Physical examination. We look at the wound, its edges and drainage, the surrounding skin, swelling and pulses in both feet.
- Ankle-brachial index. This quick blood pressure comparison between ankles and arms tells us whether arterial flow is adequate and how much compression is safe.
- Venous duplex ultrasound. In our IAC-accredited vascular lab, we map the superficial, perforator and deep veins, measure reflux and look for old clot or blockage. We pay special attention to veins running directly beneath the wound.
- A coordinated plan. We explain the findings and agree on a plan that combines wound care with vein treatment, working alongside your wound care provider or primary care doctor.
Compression: The Foundation of Ulcer Healing
Compression counteracts the high pressure that keeps a venous ulcer open. It reduces swelling, helps the calf muscle return blood upward and improves the environment around the wound. The type is chosen based on the size of the wound, the amount of drainage and your arterial results.
Multilayer bandage systems
Used for active ulcers, these wraps are applied by a clinician and changed once or a few times a week. They provide steady pressure and absorb drainage.
Unna boots and similar wraps
A medicated paste bandage that hardens slightly, creating a semi-rigid sleeve that works with the calf muscle as you walk.
Compression stockings and wraps
Ulcer stocking kits or adjustable wraps are often used for smaller wounds, and medical-grade stockings help prevent recurrence after healing. Stockings that are difficult to pull on can be managed with donning aids or zippered and wrap-style garments.
Treating the Veins Underneath the Wound
Compression manages the pressure from the outside. Treating the veins removes much of that pressure at its source. When the ultrasound shows reflux in the saphenous veins, closing them with endovenous thermal ablation or a non-thermal method lowers pressure in the skin around the ulcer.
Small refluxing veins and perforators that run directly beneath the wound bed can often be closed with ultrasound-guided foam sclerotherapy, entering through healthy skin nearby. These procedures are performed in the office under local anesthesia, and patients walk out the same day and continue their wound care as usual. Treating reflux early in the course of an ulcer, rather than waiting for it to heal first, is now commonly recommended in vascular guidelines.
Keeping a Healed Ulcer From Coming Back
Healing an ulcer is a milestone, but the skin over a healed venous ulcer remains fragile, and recurrence is common if nothing changes. The most effective protection combines several steps:
- Wear medical-grade compression stockings daily as prescribed, and replace them every few months as they lose elasticity
- Make sure refluxing veins have been treated, and have a follow-up ultrasound if swelling returns
- Moisturize the lower legs daily to prevent cracking, and treat itching early rather than scratching
- Protect the lower legs from bumps, for example with padding in cluttered spaces or when gardening
- Keep moving, with daily walks and ankle exercises while sitting
- Check your legs regularly and report any new discoloration, swelling or broken skin promptly
Seek urgent medical care if you notice:
- Redness, warmth or swelling spreading beyond the wound, red streaks, fever or chills
- A sudden increase in pain, a foul odor or a large amount of new drainage
- Sudden swelling and pain in one leg, which may be a deep vein thrombosis
- Chest pain or sudden shortness of breath
- A foot or toes that turn cold, pale, blue or numb
Venous Ulcer Evaluation and Treatment in Houston
If you have a leg wound that has not healed in a few weeks, or skin around your ankle that is darkening, itching or hardening, it is worth having your veins checked by a vein doctor in Houston who can identify the cause. Dr. Syed Raza is a fellowship-trained interventional radiologist with more than 15 years of experience treating venous reflux and peripheral arterial disease, and our accredited vascular lab performs both arterial and venous testing. We serve patients from Houston, Katy and nearby communities, usually offer same-week appointments and accept most insurance plans, including Medicare. Learn more about our venous ulcer treatment or call (832) 321-5355.
Talk With a Specialist at Premier Vein
Have questions about your symptoms or treatment options? Dr. Syed Raza and the team at Premier Vein & Vascular Center can evaluate your concerns and explain your options clearly. Same-week appointments are usually available, and most insurance plans are accepted.
Frequently Asked Questions
What does the beginning of a venous ulcer look like?
It often starts as a small break in skin that is already discolored, swollen or itchy above the ankle. Instead of healing in a week or two, it slowly widens, becomes moist and develops irregular edges.
Are venous stasis ulcers painful?
Many are, ranging from an aching or burning feeling to sharp stinging, especially when the leg hangs down. Pain often eases when the leg is elevated. Pain that worsens with elevation suggests arterial disease and needs evaluation.
How long does it take for a venous stasis ulcer to heal?
Healing time varies with the wound’s size, how long it has been open and whether the underlying vein reflux is treated. Small ulcers may close within weeks with good compression and vein treatment, while large or long-standing ulcers can take months.
Should a venous ulcer be kept covered?
Yes. Venous ulcers heal best in a moist, clean environment under an appropriate dressing, usually beneath compression. The dressing type depends on how much drainage the wound produces, and a wound care provider can tailor it.
Can you walk with a venous stasis ulcer?
Walking is encouraged for most people with venous ulcers because it activates the calf muscle pump and helps move blood out of the leg. Combine walking with compression and periods of leg elevation.
Who should I see for a leg ulcer that won’t heal?
Start with a vein specialist or vascular specialist who can test both the arteries and veins, alongside a wound care provider. Identifying and treating the cause is key to lasting healing.
Trusted Health Resources
- Chronic Venous Insufficiency, Society for Vascular Surgery
- Venous Insufficiency, MedlinePlus Medical Encyclopedia (NIH)
- Varicose Veins and Spider Veins, MedlinePlus (NIH)