Why venous ulcers recur without compression
Venous leg ulcers form because the one-way valves inside the leg veins have failed, letting blood pool in the lower leg instead of returning efficiently to the heart. That pooling creates sustained pressure that breaks down the skin, usually around the inner ankle. Compression counters the pressure and is the core treatment, not an optional add-on. Without it, a healed venous ulcer almost always returns, often in the same spot.
Why the cause must be confirmed first
Compression is highly effective for venous ulcers and potentially harmful for arterial ones, where blood supply is already reduced. A leg wound that hurts more when elevated is behaving like an arterial wound and needs assessment before compression is applied. Palm checks circulation, including pulses at the foot, before wrapping a leg, because the same wrap that heals one wound can worsen another.
How to recognize a venous ulcer
Venous ulcers tend to be shallow with irregular edges, surrounded by skin showing long-term venous changes: brownish discoloration from old blood breakdown, swelling, visible varicose veins, and skin that has thickened over time. They are usually less painful than arterial wounds, and elevation often brings some relief because it helps drainage.
What ongoing management involves
- Serial measurements to confirm the wound is contracting
- Compression adjusted as edema resolves and the limb changes
- Care for the fragile skin around the wound
- Monitoring for infection: increased pain, warmth, spreading redness, changed drainage
- Vascular referral if the wound does not respond or arterial involvement is suspected