Why Wound Care Alone Won't Heal Your Venous Leg Ulcer

If you have a wound on your lower leg that won't heal, you are far from alone. According to the Cleveland Clinic, approximately one percent of adults in the U.S. (about 3.41 to 3.42 million people) suffer from chronic, non-healing leg ulcers. More sobering, approximately four percent of people over 65 (about 13.4 to 13.5 million people) have nonhealing sores on their legs.

As a vein specialist who has treated hundreds of patients with chronic leg wounds, Mohamed T. Hassan, MD, DABVLM, RPVI, wants to share something he sees all the time in my practice in Hoover, Alabama, and Trussville, Alabama:

There is a gap in care that causes much unnecessary suffering, and I believe that, if more individuals understand the relationship between venous disease and slow-healing wounds, much of this suffering can be avoided.

If you are among these millions of people and have been going to a wound care center for months or even years without lasting results, there may be a very important reason why. 
– Dr. Mohamed T. Hassan

To understand the gap, it helps to start with the wound itself.

To schedule an appointment with Dr. Hassan, or at any of Center for Vein Restoration’s 120+ vein clinics nationwide, click below🔽

What Is a Venous Leg Ulcer?

A venous leg ulcer is an open sore that develops on the lower leg, usually near the ankle. These wounds are the most common type of chronic, non-healing wound. Research from the National Library of Medicine shows that between 70 and 90 percent of all lower leg ulcers are caused by chronic venous insufficiency, a condition in which the veins in the legs are not circulating blood the way they should.

When the veins stop working properly, blood pools in the legs instead of flowing back up to the heart. This leads to increased pressure in the veins, fluid buildup, leg swelling, skin changes, and eventually open wounds. Johns Hopkins Medicine describes this process clearly: when the one-way valves inside your leg veins weaken or fail, blood can flow backward, a condition known as venous reflux.

The Problem Most Patients Don't Know About

Here is what concerns me most. 

I see patients who have been faithfully attending wound care appointments for months. Their wounds are cleaned, dressed, and monitored. The team is doing its job. But the wound keeps coming back or refuses to heal completely.

When I ask these patients whether anyone has evaluated their veins, the answer is almost always the same: 

"No one ever told me that my leg wound could be a vein problem."

That is the gap.

Don’t get me wrong: Wound care centers do important work. Dressings, debridement, and regular monitoring all play a role in managing a venous ulcer. But wound care focuses on the wound surface; it does not address the underlying venous reflux that is causing the wound in the first place. Without treating the source, the wound may improve for a while, but it will often return.

Think of Leg Ulcers Like a Leaking Pipe in Your Wall

Here is a simple way to understand what is happening:

Imagine you notice a stain on your living room wall. The paint is peeling, and the drywall looks damaged. You patch it, repaint it, and it looks fine for a few weeks. But the stain keeps coming back because a leaking pipe inside the wall was never fixed.

You could repaint that wall every month for years. It might look better each time, but until someone repairs the pipe, the damage will keep returning, and it will probably get worse.

A leg ulcer works the same way. 

The wound on the surface of your skin is like a wall damaged by water. The venous reflux happening inside your veins is the leaking pipe. Wound care treats the visible damage. But unless the "leak" in the veins is corrected, the problem persists. This leads to a cycle of ongoing treatment that can stretch on for months or years, delaying the real fix.

What Happens When the Root Cause Goes Untreated

When venous disease is not addressed, the consequences go beyond a slow-healing wound. Patients become frustrated and discouraged. And while the quality-of-life impact is real and significant, there are also serious medical risks associated with the cycle.

In my experience, most patients I see with venous leg ulcers have been receiving conventional wound care for months without ever being evaluated for venous reflux. That is the core of the problem. Without treating the underlying reflux, delayed wound healing is nearly inevitable, and recurrence rates are high. Studies show that up to 60 to 70 percent of venous ulcers return within one year when the underlying vein disease is not corrected.

Wounds that remain open for long periods are at higher risk for repeated infections. These infections can spread into deeper tissues. In some cases, they can reach the bone, a serious condition called osteomyelitis. According to Johns Hopkins Medicine, bone infections are difficult to treat and often require hospitalization and prolonged antibiotic therapy.

In rare but important cases, a long-standing chronic wound can undergo a process called malignant transformation. This means the wound can develop into an aggressive form of skin cancer known as squamous cell carcinoma, sometimes called a Marjolin's ulcer. This is a well-documented complication of chronic non-healing wounds, and it underscores why timely, complete treatment is so important. The National Library of Medicine has documented this risk, and it is one that both patients and providers must take seriously.

The Right Approach: Treat Both the Wound and the Vein Disease

Optimal care for a venous leg ulcer must address two things at the same time: the wound itself and the underlying vein dysfunction that causes it.

Early identification matters. One of the most common presentations I see is a wound on the inner ankle, known as a medial ankle ulcer, accompanied by leg swelling and skin discoloration (hyperpigmentation). If you or someone you know has a wound fitting that description, a venous evaluation should happen right away, not after weeks of wound care alone.

Best practice calls for what I refer to as dual-track care: venous duplex ultrasound to assess for reflux, running in parallel with wound care for local ulcer management. These two approaches are not either/or. They should happen together.

Any patient with a lower leg wound should have a thorough venous ultrasound evaluation. This is a painless, non-invasive imaging test that allows a vein doctor to see exactly how blood flows through the leg veins. It can identify venous insufficiency and map exactly where the reflux is occurring. 

I am not alone in this opinion, as the Mayo Clinic recognizes duplex ultrasound as the gold standard diagnostic tool for evaluating vein problems of this kind.

The clinical evidence for treating venous reflux is compelling. When the underlying vein disease is identified and treated alongside wound care, healing time can be reduced from more than a year with conventional wound care alone to approximately two to three months. And rather than facing a 60 to 70 percent recurrence rate, patients who have their venous insufficiency corrected experience a recurrence rate of more than 90 percent. Those are not small differences. They represent months or years of suffering that can be avoided.

Once the underlying vein disease is identified, it can be treated. Modern vein treatment options are minimally invasive, performed in an outpatient vein center, and covered by most insurance plans when medically necessary. Treating the venous reflux removes the pressure and pooling that is feeding the wound, giving it a real chance to heal and stay healed.

If you have a wound that won't heal, your veins may be the reason. Center for Vein Restoration offers comprehensive venous ultrasound evaluations and minimally invasive vein treatments at 120+ locations nationwide. Most insurance is accepted.

📞 Call Center for Vein Restoration at 240-249-8250
📅 Or book online HERE

Do You Have Recurring Leg Wounds? Ask About Your Veins

If you have a leg wound that has been slow to heal or keeps coming back, ask your doctor about a venous evaluation. Wound care and vein care are not competing approaches. They work together. But vein disease must be part of the conversation from the start. Research reported by the NIH confirms that chronic venous disease is the most common cause, accounting for approximately 65 percent of leg ulcers, and supports the combined treatment approach as the most effective way to improve healing and prevent recurrence.

If you are dealing with leg pain, leg swelling, skin changes, varicose veins, or a wound that will not heal, do not wait. A consultation at a qualified vein center is the first step toward healing.

Mohamed T. Hassan, MD, DABVLM, RPVI, is a fellowship-trained vein doctor and vein specialist at Center for Vein Restoration, serving patients at vein centers in Hoover and Trussville, Alabama. He is board-certified in internal medicine and holds certification from the American Board of Venous and Lymphatic Medicine. His specialties include chronic venous insufficiency, varicose veins, spider veins, and venous ulcers. 

To schedule a consultation, visit centerforvein.com or call 240-249-8250.

Frequently Asked Questions

1. Q: How do I know if my leg wound is caused by vein disease? 
   A: The most reliable way to find out is through a venous ultrasound evaluation. A vein specialist can use this painless, non-invasive test to check how blood is flowing through your leg veins and determine whether venous insufficiency is contributing to your wound.
2. Q: Can I treat a venous leg ulcer with wound care alone? 
   A: Wound care is an important part of managing a venous ulcer, but it only addresses the surface of the problem. If the underlying venous reflux is never treated, the wound will either not heal, healing will be prolonged for many months, or, if healed, it is likely to return. The most effective approach combines wound care with treatment of the underlying vein disease.
3. Q: Does insurance cover vein treatment for leg ulcers? 
   A: In most cases, yes. When venous insufficiency is diagnosed and documented as the underlying cause of a non-healing wound, vein treatment is typically considered medically necessary and covered by most major insurance plans. A vein specialist can review your coverage during your consultation.
4. Q: What happens if a venous leg ulcer is left untreated for a long time? 
   A: Chronic, untreated venous ulcers carry serious risks beyond the wound itself. These include recurring infections, deep tissue involvement, bone infection (osteomyelitis), and, in rare cases, a type of aggressive skin cancer called squamous cell carcinoma (aka a Marjolin's ulcer). Early treatment significantly reduces these risks.