0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
JAMA Dermatology Patient Page |

Venous Ulcers FREE

Joseph McCulloch, PhD, PT, CWS
JAMA Dermatol. 2015;151(9):1044. doi:10.1001/jamadermatol.2015.58.
Text Size: A A A
Published online

Venous ulcers of the leg occur because the veins become stretched, which prevents the valves in the veins from fully closing.

Lack of exercise and lack of physical activity make the problem worse. The calf muscle pump refers to the collection of veins located deep inside the leg and that are supported by powerful muscles that help push blood back up to the heart. This muscle group is helped by the veins themselves with 1-way valves that prevent blood from flowing backward. A well-functioning calf muscle pump is important to healthy leg veins. When veins are stretched or unhealthy, or the calf muscle pump is not working well, it can lead to ambulatory venous hypertension, or high blood pressure, in the veins. This high pressure hurts blood flow and nutrition to the skin and, if not corrected, leads to skin breakdown.

DIAGNOSIS AND TESTING

Tests look at blood flow in the legs by checking the leg pressure with cuffs around the legs. Ultrasonography is used to check the blood flow. In some cases, skin cultures are used to check for infection, or biopsy may be needed.

TREATMENT

Compression therapy and exercise can improve blood flow in the veins and help heal the ulcers. Compression therapy is usually achieved with elastic and semi-elastic wraps, stockings, or even pneumatic compression systems. When ulcers are present, dressings are applied under the compression wraps to help the wounds heal. Wound management health care professionals, including dermatologists, can recommend the best wound dressings and compression. Wound dressings are complicated and may require daily or twice-daily care, including cleansing and the use of topical medications and special types of bandages to protect the ulcer and help it heal.

Exercise should focus on strengthening the calf muscles. This may be as simple as standing heel rises performed several times a day, repeated 20 to 30 times, or full-stride walking or stair climbing. In all cases, supportive compression garments and good-fitting athletic shoes should be worn. When sitting or lying down, raising the leg to the height of the hip and keeping it up after exercise will limit swelling.

Supervised physical therapy may also be of benefit. The therapist can plan custom exercises and can use technologies such as electrical stimulation, ultrasound, and pneumatic compression to help ulcers heal.

Box Section Ref ID

For More Information

To find this and other JAMA Dermatology Patient Pages, go to the Patient Page link on the JAMA Dermatology website at http://www.jamaderm.com.

ARTICLE INFORMATION

Section Editor: Misha Rosenbach, MD
The JAMA Dermatology Patient Page is a public service of JAMA Dermatology. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA Dermatology suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call (312) 464-0776.

Conflict of Interest Disclosures: None reported.

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

14,435 Views
1 Citations
×

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Peripheral Arterial Disease

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Make the Diagnosis: Peripheral Arterial Disease