Understanding and Managing Leg Ulcers: Causes, Symptoms, and Treatment Strategies

Understanding and Managing Leg Ulcers: Causes, Symptoms, and Treatment Strategies

The skin on the lower leg is dry, reddened, and itchy, with later brown pigment spots, weeping eczema, and hardening of the skin form. It creates an open spot that won’t heal. Almost a million people in Germany suffer from leg ulcers, primarily due to vein problems.

Occurrence of leg ulcers

Ulcus cruris tends to occur in old age and has serious economic consequences It is assumed that almost 15% of adult Germans have a chronic venous disease – the most common cause of leg ulcers. The treatment costs for venous leg ulcers alone are estimated at around 1.5 billion euros or 1-2% of the health insurance budget in Germany. As the population ages, these will likely increase over the next few years. Effective prevention and therapy are, therefore, important.


How does a leg ulcer develop?

Poorly healing, deep wounds on the lower legs are almost always caused by vascular diseases and not – as one might think at first glance – by a skin disease. The ulcer develops based on an undersupply of the tissue.

In more than 70% of cases, there is a venous disorder (Ulcus cruris venosum); in about 8%, an arterial disease (Ulcus cruris arteriosum); 14% are caused by simultaneous changes in the venous and arterial system (Ulcus cruris mixtum):

  • Venous leg ulcers (Ulcus cruris venosum): In the event of venous insufficiency or after a thrombosis, the blood backs up in the legs, which initially leads to water retention (oedema) and later also to hardening of the skin and connectivesss tissue. The back pressure continues into the capillaries, the finest blood vessels between arteries and veins. As a result, the blood flow slows down or stops entirely so that sufficient oxygen and nutrients can no longer be released from the blood into the surrounding tissue. The tissue swelling caused by the oedema makes the exchange of substances more complex, compressing the vessels from the outside.
  • Arterial leg ulcer (Ulcus cruris arteriosum): In arterial vascular disease, hardening of the arteries leads to narrowing of the arteries up to complete closure of the arteries. This initially affects the small and smallest vessels. The surrounding tissue is also undersupplied, with the possible result of an ulcer.
  • Other forms: Less commonly, leg ulcers are caused by restricted joint function, e.g. of the upper ankle joint (arthrogenic congestion syndrome), infections (infectious ulcus), blood diseases (haematopoetic ulcus), cancer (neoplastic ulcer) or other diseases (e.g. ulcerative colitis ).



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