Venous Leg Ulcers: Causes, Treatment, and How to Prevent Recurrence

Venous leg ulcers are the most common chronic wound in adults, accounting for approximately 70–80% of all leg ulcers. They're painful, slow to heal, and highly prone to recurrence — but with the right treatment, most can be healed and kept from coming back. If you or someone you care for has a venous leg ulcer, this guide will help you understand what's happening and what effective treatment looks like.

What Is a Venous Leg Ulcer?

A venous leg ulcer is an open wound on the lower leg caused by chronic venous insufficiency — a condition in which the veins in the legs fail to return blood efficiently to the heart. Blood pools in the lower leg, increasing pressure in the veins (venous hypertension), which damages the skin and underlying tissues over time.

Venous leg ulcers most commonly appear on the inner ankle area (the gaiter area) and tend to be shallow with irregular borders and a weeping wound bed.

What Causes Venous Insufficiency?

The veins in the legs contain one-way valves that prevent blood from flowing backward. When these valves are damaged or weakened — by deep vein thrombosis (DVT), injury, pregnancy, prolonged standing, or simply aging — blood pools in the lower leg instead of returning to the heart.

Risk factors for venous insufficiency and venous leg ulcers include:

• History of deep vein thrombosis (DVT)
• Obesity
• Pregnancy (especially multiple pregnancies)
• Prolonged standing or sitting occupations
• Age over 60
• Family history of varicose veins or venous disease
• Previous leg injury or trauma

How to Recognize a Venous Leg Ulcer

Treatment: Compression Therapy Is the Foundation

The most important treatment for venous leg ulcers is compression. By applying sustained external pressure to the lower leg, compression therapy counteracts venous hypertension, reduces swelling, and restores blood flow toward the heart.

Multi-layer compression bandaging is the gold standard for active venous ulcers. A system of two to four layers is applied from the foot to the knee, providing graduated pressure (highest at the ankle, decreasing toward the knee). Bandages are changed every one to two weeks at wound care appointments.

Compression stockings (once the ulcer has healed) maintain the benefit of compression and are the primary tool for preventing recurrence. Medical-grade stockings provide 20–40 mmHg of compression. They must be worn consistently — every day, from morning to bedtime.

Research consistently shows that compression healing rates (50–70% of ulcers healed at 12 weeks) far exceed those of wound care alone without compression. Yet compression remains underused because patients find it uncomfortable and providers don't always prescribe it aggressively.

Wound Care for Venous Ulcers

In addition to compression, venous ulcers require regular wound care:

Cleansing and debridement: The wound is cleaned at each visit. Slough (stringy yellow dead tissue) is removed through debridement to allow healthy tissue to form.

Moisture-retentive dressings: Venous ulcers produce significant drainage. Highly absorbent dressings — alginate, foam, or hydrofiber — manage this moisture while maintaining a healing environment. Dressings are changed one to three times per week depending on drainage levels.

Infection management: Venous ulcers are prone to bacterial colonization and infection. Signs of infection (increasing pain, redness, odor, systemic symptoms) require prompt treatment with appropriate antibiotics.

Advanced therapies for non-healing ulcers: Ulcers that don't respond to compression and standard wound care within 4–6 weeks may benefit from biological skin substitutes, negative pressure wound therapy, or other advanced treatments.

How Long Does a Venous Leg Ulcer Take to Heal?

With consistent compression therapy and wound care, most venous leg ulcers heal within 3–6 months. Larger, older ulcers may take longer. Factors that predict slower healing include:

• Large wound size (greater than 10 cm²)
• Ulcer present for more than 6 months before treatment
• Poor compression compliance
• Significant obesity
• Concurrent arterial disease

If a venous ulcer is not showing improvement after 4–6 weeks of appropriate treatment, escalation of care is warranted.

Preventing Recurrence — the Critical Challenge

Venous leg ulcers recur in 40–70% of patients within five years of healing. The reason is that compression therapy heals the wound, but doesn't fix the underlying venous insufficiency. Preventing recurrence requires:

Lifelong compression stocking use. This is the single most effective prevention strategy. Class 2 (30–40 mmHg) stockings worn daily dramatically reduce recurrence rates.

Leg elevation habits. Building elevation into your daily routine maintains the benefit of compression.

Skin care. Keep the skin around the healed area moisturized to prevent cracking, which can trigger a new ulcer.

Vascular evaluation. Ask your doctor whether venous ablation procedures (such as endovenous laser treatment or sclerotherapy) are appropriate for you. Treating the underlying venous insufficiency reduces recurrence risk significantly.

Weight management. Obesity increases venous pressure. Even modest weight loss reduces recurrence risk.

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The Bottom Line

Venous leg ulcers are chronic wounds that require sustained, consistent treatment — not just dressing changes. Compression therapy is the foundation of healing, and continuing compression after healing is essential to prevent the wound from returning. A wound care specialist can design a comprehensive treatment plan and help you find the strategies that make long-term compression manageable in your daily life.