What it is
A leg ulcer is an open sore on the leg or foot that is slow to heal. Many are linked to circulation: blood either has trouble returning from the legs to the heart (venous) or has trouble flowing into the legs (arterial). Other factors, such as diabetes, pressure, injury or certain medical conditions, can also play a role.
Venous ulcers, sometimes called venous stasis ulcers, are associated with veins whose valves are not working as well as they should. Blood can pool in the lower leg, raising pressure in the tissue. Venous stasis ulcer causes commonly discussed include chronic venous insufficiency, past blood clots and long periods of standing or sitting. These ulcers often appear on the lower leg near the ankle, may have uneven edges, and can come with swelling or skin darkening.
Arterial ulcers are associated with reduced blood supply to the legs and feet, often from narrowed or blocked arteries. When tissue does not receive enough oxygen-rich blood, even a small injury can struggle to heal. In the arterial ulcer vs venous ulcer comparison, arterial ulcers more often show up on the toes, heels or other pressure points, may look "punched out," and can be painful, with skin that feels cool or looks pale. Only a licensed clinician can tell which type, or which combination, a person has.
How it’s traditionally been approached
Because the causes differ, leg ulcers have traditionally been evaluated before they are treated. A clinician typically asks about health history, examines the leg and foot, and may check pulses and circulation. Tests that look at blood flow in the arteries or veins are sometimes used to learn what is driving the wound.
For venous ulcers, compression therapy has long been a cornerstone of care. Compression, such as specialized bandages, wraps or stockings, applies external pressure to the leg to help support blood returning toward the heart and reduce swelling. It is not appropriate for everyone, particularly when arterial blood flow is reduced, which is why a clinician usually checks circulation first.
Arterial ulcers have traditionally been approached by looking at blood supply, since healing depends on oxygen reaching the tissue. Vascular specialists may be involved to assess whether circulation can be improved. Across both types, general wound care often includes cleaning the wound, choosing dressings that manage moisture, protecting the skin, and watching for infection. Some clinics also discuss options such as negative pressure wound therapy, skin substitutes or hyperbaric oxygen for selected situations, and a provider decides whether any of these fit.
How the right wound care specialist may help
The right wound care specialist may help by looking for the reason a leg ulcer has stalled instead of treating only the surface of the wound. A visit often begins with a conversation about when the sore started, any pain, swelling, past clots, diabetes, smoking history, medicines and daily activity. The clinician examines the wound, measures it, and may check circulation in the leg.
Specialists often work with other professionals, such as vascular providers, podiatrists, primary care clinicians and nurses, depending on what the evaluation shows. If someone says a venous ulcer won't heal, a specialist may reassess the cause, whether circulation or swelling is being addressed, whether infection or other barriers are present, and whether the current approach still fits. Some newer options, like skin substitutes or amniotic and placental products, vary in FDA status (most are regulated as minimally manipulated tissue rather than FDA-approved drugs), and coverage differs by product and payer. Ask a provider about them rather than assuming they apply. Amnioticdoctors.com is one place for further reading on amniotic products specifically, and it is not affiliated with WoundKare.
Helpful questions to bring to an appointment include: What is causing my ulcer, and is it venous, arterial or mixed? How is it staged? What treatment options exist for my situation and why? Is compression appropriate for me? How long might healing take, and what could slow it? What will my insurance cover? Outcomes vary from person to person, and no provider can promise a specific result.
The whole-person view
Living with a slow-healing leg wound is about more than the skin. Pain, poor sleep, limited movement, frequent appointments and worry about the wound can wear on mood and energy, and stress can in turn affect sleep, habits and how the body feels. Body, mind and stress influence one another, so caring for the whole person is a reasonable part of the picture alongside medical care.
Some people find body-based support helpful for tension and stress, such as the approaches listed through Somatic Experiences. Others value talking with someone about the frustration of a long recovery, which is where a counselor through Therapists.plus may fit. These are complements to, not replacements for, care from a licensed wound care provider.
Somatic Experiences: trauma and emotional healing →Somatic Experiences: embodiment and movement →Therapists.plus: mind body connection →
Keep in mind
- Licensed professionals should guide the diagnosis and care of any leg ulcer, since the right approach depends on the cause, and compression in particular is not safe for every leg.
- Seek medical care promptly for signs of infection, including spreading redness, red streaking, increasing warmth or pain, pus, foul odor, fever or chills, or if a wound is getting worse quickly.
- Call 911 or go to the ER for heavy bleeding, exposed bone or tendon, signs of sepsis, or a deep or severely contaminated wound. If you are in emotional crisis, call or text 988.
- This page is educational only and is not medical advice. Ask a licensed provider about your wound's cause, staging, treatment options, expected healing time and insurance coverage.
Guides in this topic
Wound care specialist types
Frequently asked questions
What is the difference between an arterial ulcer and a venous ulcer?
Venous ulcers are linked to blood having trouble returning from the legs to the heart, while arterial ulcers are linked to reduced blood flow into the legs and feet. Venous ulcers often appear near the ankle with swelling, and arterial ulcers more often appear on the toes, heels or pressure points and can be quite painful. Only a clinician can confirm which type you have, since some people have both.
What causes venous stasis ulcers?
Venous stasis ulcers are commonly associated with chronic venous insufficiency, where weakened vein valves let blood pool in the lower leg and raise pressure in the tissue. Past blood clots, long periods of standing or sitting, and other factors may contribute. A provider can look at your history and circulation to find the cause in your case.
How does compression therapy for leg ulcers work?
Compression therapy applies external pressure to the leg, using wraps, bandages or stockings, to help support blood flow back toward the heart and reduce swelling. It has long been used for venous ulcers. It may not be safe if arterial circulation is reduced, so a clinician should check your circulation and decide whether and how it is used.
Why won't my venous ulcer heal?
A venous ulcer that won't heal may have an underlying issue that has not been fully addressed, such as ongoing swelling, reduced circulation, infection, or another health condition. A wound care specialist can reassess the cause and what may be slowing healing. Ask your provider about your wound's staging, options and expected healing time.
What is the usual approach to arterial ulcer treatment?
Arterial ulcer treatment generally focuses on evaluating blood supply, since tissue needs oxygen-rich blood to heal, and often involves vascular specialists along with wound care. Compression is usually approached with caution. A licensed clinician decides what is appropriate after an evaluation, and outcomes vary.
When should I see a doctor about leg ulcer wound care?
See a licensed provider for any leg sore that is not healing, keeps returning, or comes with new swelling or pain. Seek care promptly for spreading redness, red streaking, pus, foul odor, increasing warmth or pain, fever or chills. Call 911 or go to the ER for heavy bleeding, exposed bone or tendon, or signs of sepsis.
Educational resource. WoundKare shares general information and connects people with independent wound care specialists. It is not medical advice, diagnosis or treatment. Talk with a licensed professional about your health.