Top Four Causes of Leg Ulcers

Medically reviewed by Evan Harris, MD, DVIR, DABVLM, RPVI, on June 5, 2025

Have you ever wondered why some scrapes on your leg heal so slowly? For many people, the culprit isn’t just the scrape itself, but a deeper issue hidden in the veins below the skin. In fact, according to the National Library of Medicine, about 70 percent of chronic leg ulcers are linked to vein problems such as weakened valves, blood clots, or bulging vein walls that let blood pool and raise pressure on nearby tissues. But why?

Your leg veins carry blood back up to your heart, and when they don’t work properly, blood can pool and put extra pressure on the surrounding tissues. This pressure gradually makes the skin fragile and slows the natural repair process, so even a minor cut or insect bite can turn into a stubborn ulcer. Understanding this connection is the first step toward finding a lasting solution.

In this blog, Dr. Evan Harris, lead vein physician at our Center for Vein Restoration (CVR) clinics in Glastonbury, CT, and Middletown, CT, explores four leading causes of leg ulcers and outlines the signs that indicate a visit with a vein care specialist is needed.

Take control of your vein health today! Contact CVR to book your expert consultation and get a customized plan to heal and prevent leg ulcers. Call 240-249-8250 or click the button below to start your vein care journey. ⬇️

Understanding Leg Ulcers

First, it’s important to understand the difference between leg ulcers and other skin injuries. Leg ulcers don’t appear suddenly; they form slowly as a sign that the skin on your lower legs is no longer getting the blood, oxygen, or protection it needs. Most start small and are highly treatable, but only when patients proactively seek care. Four common causes of leg ulcers include:

1. Venous (Stasis) Ulcers

When one-way valves in the leg veins fail, blood pools in the lower leg and ankle. That fluid seeps into surrounding tissues, stretching the skin and depriving it of nutrients. Even minor trauma, such as an insect bite or a scratch, can evolve into an open sore that resists healing.

• Location: Just above the inner ankle or lower shin
• Signs: Swelling, itching, and reddish-brown skin discoloration
• Symptoms: Pain often decreases when the leg is elevated

Left untreated, venous stasis ulcers can enlarge, leak fluid, and become infected. Modern, minimally invasive procedures such as laser and radiofrequency ablation close the faulty veins and restore healthy circulation, giving the skin a chance to recover.

2. Arterial (Ischemic) Ulcers

Narrowed or calcified arteries restrict oxygen-rich blood to the feet and toes. Without an adequate supply, skin cells die and form sharply defined wounds. Even though they’re often less than two inches in diameter, arterial ulcers can cause a great deal of pain, especially at night or when the leg is elevated.

• Location: Typically on the foot, heel, or toes
• Signs: Cool, pale, or bluish skin; weak or absent foot pulses
• Symptoms: Pain relieved by dangling the leg

According to the National Library of Medicine, arterial ulcers indicate peripheral artery disease, which increases the risk of heart attack and stroke. Early vascular imaging, such as duplex ultrasound or CT angiography, can localize blockages, and coordinated arterial and venous care can restore perfusion before tissue loss progresses further.

3. Neuropathic (Diabetic) Ulcers

Elevated blood sugar in diabetes damages the small blood vessels responsible for wound healing and the peripheral nerves that send pain signals to the brain. Repeated pressure, such as friction from footwear, can go unnoticed when sensation is reduced. Reduced capillary flow also hinders healing.

• Location: Ball of the foot, big toe, or heel
• Signs: Callus formation around a circular ulcer; possible deep tissue involvement
• Symptoms: Often painless until infection develops

Infection dramatically prolongs healing and raises the risk of amputation. Keeping blood sugar under control and checking your arteries and veins helps wounds heal faster and keeps you moving.

4. Pressure (Decubitus) Ulcers

Commonly called bedsores, pressure ulcers form when skin and tissue stay compressed for too long over bony spots, blocking blood flow. Early on, the area turns red and feels sore. If pressure continues, blisters, open sores, and tunnels under the skin can form.

• Location: Heels, tailbone, hips, sitting bones, or back of the ankle
• Signs: Red or purple patches that may blister, break open, or develop tunnels under the skin edge
• Symptoms: Pain or discomfort at the site, or no pain if the tissue has died

Prevent and treat pressure ulcers by changing position often, using pressure-relief cushions or boots, and checking vein blood flow. Early pressure relief and vein health monitoring can stop sores from worsening and help them heal.

Why Healthy Veins Are Your Best Defense

Left untreated, vein problems don’t just cause ulcers. They can lead to infection, pain, and loss of mobility. A vein specialist (phlebologist) can:

1. Diagnose the exact vein issue with ultrasound.
2. Offer treatments including compression stockings and minimally invasive procedures such as laser ablation or ambulatory phlebectomy
3. Prevent ulcers from forming again by fixing the root cause, not just bandaging the wound.

Early intervention speeds healing, reduces pain, and lowers the chance of future ulcers. Modern treatments are often quick, with most patients returning to normal activities in days, with no long hospital stays required.

Taking the Next Step Toward Healthier Legs With CVR

If you think you may have a leg ulcer, or you’re developing symptoms such as swelling, pain, or varicose veins, don’t wait. Each of the ulcers above has one common prevention method: early intervention.

Reach out to a board-certified vein specialist at CVR today. The right diagnosis and treatment plan promotes faster healing, preventing complications and allowing patients to return to their day-to-day life without the constant worry of painful sores.

Schedule your appointment now and take the first step toward healthier veins and healthier legs. Call 240-249-8250 or use our ONLINE SCHEDULING PORTAL to book a consultation at a CVR vein clinic near you.

Frequently Asked Questions

1. What are common risk factors for leg ulcers?
   Older age, obesity, diabetes, smoking, and high blood pressure increase the risk of leg ulcers.
2. How long does it take for a leg ulcer to heal?
   With proper care, many leg ulcers start to improve in 4–6 weeks, but some may take months.
3. What signs suggest a leg ulcer is infected?
   Yellow or green pus, increased pain, redness spreading around the sore, and a foul smell indicate infection.
4. Do leg ulcers come back after they heal?
   Yes, without ongoing care like compression and skin checks, leg ulcers can recur.
5. When should I see a doctor about a leg ulcer?
   See a doctor if a sore on your leg does not start to heal within two weeks or shows signs of infection.