Leg Ulcers: Causes, Symptoms, and Effective Treatment

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Leg ulcers are chronic open sores, typically found between the ankle and the knee, that fail to heal within two weeks. They are often caused by poor circulation, diabetes, or high blood pressure, and they need specialized medical care to prevent serious complications such as bone infections or sepsis. Management focuses on treating the underlying cause, reducing swelling, and promoting long-term healing through compression therapy and lifestyle changes [1].

Quick Answer: What are leg ulcers?

Leg ulcers are open wounds on the lower leg, usually between the ankle and knee, that take more than two weeks to heal despite treatment. They often result from chronic venous insufficiency, diabetes or peripheral artery disease and affect about 1% of American adults. Treatment includes compression, debridement and elevation; untreated ulcers can cause cellulitis, bone infection or limb loss. [1]

What the research says

• Compression speeds up the healing of venous leg ulcers. A Cochrane review of 48 randomised trials (4,321 participants) found that healing outcomes, including time to healing, are better with compression than with no compression, and that high-compression stockings healed more ulcers than short-stretch bandages at two to four months (risk ratio 1.62, 95% CI 1.26 to 2.10) (O'Meara et al., Cochrane Database Syst Rev, 2012 [2]).

• Wearing compression after healing helps keep ulcers from coming back. In a Cochrane review of four trials (979 participants), one trial of 153 people with recently healed venous ulcers found that compression significantly reduced recurrence at six months (risk ratio 0.46, 95% CI 0.27 to 0.76), although rates of intolerance to compression hosiery were high (Nelson and Bell-Syer, Cochrane Database Syst Rev, 2014 [3]).

• Hyperbaric oxygen shows only short-term benefit, and the evidence is limited. A Cochrane review of 12 trials (577 participants), mostly in people with diabetic foot ulcers, found that pooled data from five trials (205 participants) showed more ulcers healed at six weeks with hyperbaric oxygen (risk ratio 2.35, 95% CI 1.19 to 4.62) but no benefit at one year, and the authors were not confident in the results because of design flaws (Kranke et al., Cochrane Database Syst Rev, 2015 [4]).

What are Leg Ulcers?

A leg ulcer is a wound on the lower leg that persists for more than two weeks despite treatment [1]. These sores are most often found between the ankle and the knee. A sore that has not healed after three months of treatment is considered a chronic condition.

Leg ulcers often seep fluid or pus and can grow larger if left untreated. Anyone can develop them, but they are much more common in older adults: about 1% of American adults have leg ulcers, and about 4% of people over age 65 have nonhealing sores on their legs [1]. Early identification and specialized wound care are essential to stop the sore from progressing.

Venous, arterial, and diabetic ulcers differ in appearance and location.

What causes leg ulcers, and who is at risk?

Leg ulcers are usually a symptom of a wider health problem rather than a simple skin injury. The most common causes involve the circulatory system and its ability to carry blood and nutrients to the legs [1].

Category	Contributing Conditions and Risk Factors
Circulatory Issues	Chronic venous insufficiency, peripheral artery disease (PAD), and atherosclerosis.
Systemic Diseases	Diabetes (causing narrowed vessels and nerve damage) and rheumatoid arthritis.
Blood Pressure	Chronic hypertension, which can lead to painful Martorell ulcers.
Physical Factors	Obesity, pregnancy, lack of activity, and a history of varicose veins or blood clots.
Lifestyle & History	Smoking, family history of vein problems, and previous hip or knee replacements.

What are the symptoms and warning signs of leg ulcers?

The first sign of a leg ulcer is a wound on the lower leg that shows no sign of healing after two weeks. The sore may be red, purple, brown, or yellow, or a mix of colors [1]. Beyond the visible wound, people may notice:

• Skin changes: Dry, scaly, or intensely itchy skin around the area, sometimes with hardened skin or bumps.

• Discoloration: Skin that looks bruised, with red, blue, or purplish hues.

• Physical discomfort: Persistent leg pain, particularly after long periods of standing, and swelling (edema) in the lower legs.

Compression therapy and careful wound care are central to treating leg ulcers.

If you have a fever or chills, severe pain that interferes with sleep or daily activities, or signs of infection such as redness, warmth, swelling, or foul-smelling discharge, seek medical attention promptly [1].

How are leg ulcers diagnosed?

Finding the cause of a leg ulcer calls for a vascular specialist, a provider who understands both the circulatory system and wound care. The process begins with a thorough examination of the wound and the surrounding skin [1].

To assess blood flow and pressure in the legs, specialists often use an ankle-brachial index (ABI) test, which uses ultrasound technology. In some cases a biopsy of skin cells or wound fluid is taken to check for infection or other skin diseases. These tests guide a treatment plan that targets the specific cause of the ulcer [1].

How are leg ulcers managed and treated?

Leg ulcer treatment can take months or even years and aims to heal the wound, reduce swelling and prevent the ulcer from returning. The main goals are to heal the existing wound, reduce swelling, and prevent the ulcer from returning [1]. Effective strategies include:

1. Compression therapy: Specialized stockings or bandages that stimulate blood flow and reduce pressure in the leg veins. Compression is mainly for venous ulcers, and blood flow is checked first (such as with an ABI test), because strong compression can be harmful if the leg arteries are narrowed.

2. Leg elevation: Keeping the legs raised above the heart for one hour a day, for at least six days.

3. Advanced wound care: Debridement (removal of dead tissue), topical antiseptics to prevent infection, and regular dressing changes.

4. Medical interventions: Antibiotics for infection, vasodilators to improve circulation, and, in some cases, hyperbaric oxygen therapy or skin grafts.

Conclusion

Leg ulcers are hard to treat and can limit mobility and quality of life, but they can be managed with the right clinical support. Success depends on specialized wound care and on controlling underlying conditions such as diabetes and high blood pressure. Heart-healthy habits, compression therapy as directed, and watching for early signs of recurrence help promote healing and protect long-term health and independence [1].

Elevating the legs above heart level helps reduce swelling and supports healing.

Professional Consultation and Support

If you have a nonhealing wound on your leg, consult a vascular specialist or a dedicated wound care clinic. Early treatment is the most effective way to prevent serious complications and speed healing.

Frequently Asked Questions

What is a leg ulcer?

A leg ulcer is an open sore on the lower leg that takes more than two weeks to heal despite treatment.

How common are these ulcers?

Leg ulcers affect about 1% of all adults and approximately 4% of people over the age of 65.

What are the main causes?

The most common causes are chronic venous insufficiency, diabetes, peripheral artery disease, and high blood pressure.

What does a leg ulcer look like?

A leg ulcer appears as a nonhealing sore that may be red, yellow, or purple and often has a liquid discharge.

Are leg ulcers painful?

Yes, they can cause significant pain, especially after standing for long periods.

How are they diagnosed?

Diagnosis is typically made by a vascular specialist through physical exams and tests like the Ankle-Brachial Index (ABI).

What is compression therapy?

Compression therapy involves wearing special stockings or bandages to improve blood flow and reduce leg swelling.

Can leg ulcers lead to amputation?

If left untreated, complications like bone infections (osteomyelitis) can potentially lead to limb loss.

How can I prevent recurrence?

Prevention includes elevating your legs, maintaining a healthy weight, quitting smoking, and wearing compression stockings.

When should I see a doctor?

You should see a provider if a wound doesn't heal in two weeks or if you notice signs of infection like fever or foul odors.

Related Reading

Venous Ulcers: Symptoms, Causes, and Recovery explains the most common type of leg ulcer and how it heals.

Chronic Venous Insufficiency (CVI): What It Is, Why It Happens, and How It Gets Treated covers the vein problem behind many slow-healing leg ulcers.

Peripheral Artery Disease (PAD): Symptoms, Causes, Diagnosis & Treatment Options explains how narrowed leg arteries can cause painful arterial ulcers.

Compression Therapy: Types, Pressure Levels, Benefits, and Risks — What You Need to Know describes compression stockings and wraps used to heal venous leg ulcers.

References

1. Cleveland Clinic. Leg Ulcers. Cleveland Clinic. June 23, 2022. https://my.clevelandclinic.org/health/diseases/23329-leg-ulcers

2. O'Meara S, Cullum N, Nelson EA, et al. Compression for venous leg ulcers. Cochrane Database of Systematic Reviews. 2012;11:CD000265. PMID 23152202. https://doi.org/10.1002/14651858.CD000265.pub3

3. Nelson EA, Bell-Syer SEM. Compression for preventing recurrence of venous ulcers. Cochrane Database of Systematic Reviews. 2014;9:CD002303. PMID 25203307. https://doi.org/10.1002/14651858.CD002303.pub3

4. Kranke P, Bennett MH, Martyn-St James M, et al. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews. 2015;6:CD004123. PMID 26106870. https://doi.org/10.1002/14651858.CD004123.pub4

Medical disclaimer

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The clinical information in this guide reflects source material last reviewed in June 2022.