Non‐Healing Leg or Ankle Wounds



Leg and foot wounds have become a huge problem in the United States and thankfully there are thousands of Wound Care Centers to help with the day to day care of these. However, the main underlying reason to the non-healing of these wounds is a problem with the circulation to the leg/foot. This can be either on the arterial side (delivery of oxygen and nutrients necessary to heal) or on the venous sid​ e. ​ e (removing toxins and fluid). It is felt that about 70% of people who seek care at Wound Care Centers have an underlying circulation issue, and despite going to these places, this problem is often not diagnosed or considered after months of futile debridements and dressing changes. It is critical to have circulation evaluated promptly in any patient over the age of 50, especially if there is a history of smoking, diabetes, or hypertension.


Vein problems cause most of the ulcers on the legs treated in wound care centers. These wounds are called “venous leg ulcers”, because they are located in the middle or lower part of the leg, usually above the ankle. These ulcers may be quite large (5-10 cm diameter) and may be “ugly” in appearance, but they are usually not painful. If there is associated pain, the pain is frequently relieved by elevation of the extremity. The skin around these ulcers may be brownish in color and may be firm to touch (not soft and supple), for many years before the ulcer begins. A common cause of leg ulcers is reflux (abnormal blood flow) in the veins of the leg, specifically the saphenous vein.


This problem can be treated permanently by the physicians at South Bay Vascular Center & Vein Institute with an out-patient procedure done in the office. Otherwise, venous leg ulcers tend to recur over time, especially if an appropriate treatment regimen with compression hose has not been followed. With venous leg ulcers, the risk of limb loss is low.


Arterial ulcers, on the other hand, are usually very painful. They are most often located in the foot or toes, i.e. further from the blood flow pump (the heart). Pain is the primary complaint for these patients, especially pain at night if their foot is not kept below the heart. In fact, many patients tell us they sleep with the foot hanging off the bed, to relieve their pain. The wound itself may be small (1-2 cm diameter), and is usually dry. For example, it may be just the tip of a toe. These wounds do not often look as “ugly” as a venous leg ulcer, because there is not enough blood flow to make pus or drainage. The skin around the wound is sometimes red, tender, and swollen, because bacteria can get though the skin and invade the surrounding tissues. This problem needs urgent treatment, and the risk of limb loss is high.


Diabetes patients also frequently get ulcers of the foot and toes, but that is primarily because of poor sensation (numbness) of the feet. The technical term for this numbness is “peripheral neuropathy.” Many of these patients also have arterial problems, with resultant poor arterial blood flow. This group of patients is at especially high risk of limb loss.


The physicians at South Bay Vascular Center & Vein Institute are, in a broad sense, experts in the field of vascular disease. Therefore, they and are best qualified to determine the cause of a leg/foot ulcer, and will initiate a treatment plan that is best for you. Today, most of the evaluation and even treatment of these issues can be done with the help of our ICAVL accredited vascular lab and our state-of-the –art angiography suite.