Prevention of an initial venous leg ulcer

To reduce the risk of a venous leg ulcer, advise patients to:

  • optimise their nutritional status—see Nutrition
  • lose weight, for patients who are overweight or obese
  • avoid prolonged standing or sitting
  • optimise comorbidities (especially blood glucose concentration in patients with diabetes)
  • stimulate calf muscle pump function with exercises—see Exercise
  • elevate legs to 90 degrees (to the level of the hips) when sitting
  • moisturise skin on lower limbs to improve skin integrity—see Skin care for venous dermatitis
  • use compression to prevent deep vein thrombosis and improve venous return.

Preventing venous hypertension is the key management strategy in preventing a venous leg ulcer. Early referral to a vascular or venous specialist to correct venous insufficiency is an important strategy to prevent leg ulceration. Refer patients at increased risk:

  • male patients with varicose veins
  • patients with diabetes and varicose veins
  • patients with a previous serious leg injury (eg broken leg, burn, stab or gunshot wound, crush injury) and varicose veins
  • patients with symptomatic varicose veins (pain, aching, discomfort, swelling, heaviness and itching)
  • patients with skin changes on the lower limb likely related to chronic venous insufficiency (eg pigmentation, eczema)
  • patients with superficial vein thrombosis (hard, painful veins) and suspected venous incompetence.

Progression of venous disease from varicose veins to chronic venous insufficiency is associated with the following:

  • female gender
  • age older than 70 years
  • body mass index (BMI) more than 25 kg/m2
  • elevated blood pressure.