Ankle ulcers: Causes, symptoms, diagnosis and Treatment

Ankle ulcers are slow healing, open wounds found in the ankle. It is sometimes a painful condition that results in the breakdown of skin tissue. It is more likely to occur among smokers than non-smokers. This article will tell you all about ankle ulcers, including its causes, symptoms, diagnosis, and treatment.

What are ankle ulcers?

Ankle ulcers are open sites or wounds that appear over the ankle. They are slow to heal or tend to recur over and over again. It is sometimes a painful condition that results in the breakdown of skin tissue. There are 3 different type of ulcers including:

1. Venous stasis
2. Neurotrophic
3. Arterial ulcers.

Venous stasis is the most common type of ulcers that appear over the ankles and is responsible for about 80% to 90% ulcers of the lower legs.

What are the causes of ankle ulcers?

The main reason behind venous stasis ulcers is usually due to venous hypertension or chronic venous insufficiency. In this condition, the blood does not flow from the lower legs back to the heart as it is supposed to and therefore causes a build-up of pressure within the veins. This raised pressure can lead to ulceration of the skin. There will be heavy swelling in the feet and ankles which will also make walking difficult. These ulcers can also be accompanied by water retention, which only adds to skin irritation. These venous stasis ulcers usually form over the internal aspect of the leg just above the ankle.

The exact mechanism of how venous hypertension causes venous stasis ulcers is not yet known but doctors believe that this condition causes a reduction in the blood flow to the capillaries of the leg. This results in an increase of white blood cells over the area. This accumulation of white blood cells reduces the oxygen supply to the tissue, which damages them and forms the ulcers.

Who is at risk of developing ankle ulcers?

The following factors may increase the risk of ankle ulcers in an individual has:

• Past history of leg swelling
• Past history of blood clots
• The presence of varicose veins
• History of inflammatory diseases
• Family history of ulcers
• Smoking increases the risk of ulcers because it interferes with the flow of oxygen through the blood.

What are the symptoms of ankle ulcers?

The symptoms of ankle ulcers include:

• Slight sense of burning and itching
• May or may not be painful
• Red with yellow skin over the ulcers
• If the ulcer is infected, there will be a discharge of yellow or green fluid.
• The skin may be warm or hot to touch.
• The surrounding area of the skull will be swollen and discolored.
• Leg pain – This will depend on how swollen the ankle is.
• The skin may feel very tight and therefore give a shiny appearance to the skin.

How are ankle ulcers diagnosed?

At your first visit to the doctor, he or she will first take a detailed history from you regarding the ulcers including symptoms, past medical history and family history of ulcers. Therefore, have a record of all of your symptoms that you experienced when the ankle ulcer developed. This will help your doctor to make an accurate diagnosis. After taking the history, your doctor will examine your leg and may order further testing to be done. These tests may include workups of your blood levels and vessels to ensure proper functionality. If you have had the ulcer for a long time, then your doctor may take a sample of the tissues for a biopsy to exclude cancer. Other tests your doctor might order include MRI scans, CT scans, and radiographs to check the depth of the ulcer to see if it has reached the bone. If you have been suffering from varicose veins for an extended period of time, the ankle ulcers are more pronounced. Discoloration of the skin is also seen to a large extent.

How are ankle ulcers treated?

The main aim in the treatment of venous stasis ulcers is to heal the wound, treat any infections and relieve the pain.  In addition, compression therapy may also be used to bring down the swelling. This helps to heal the wound much faster and prevent the development of repeated ulcers. There are several methods of compression including compression stockings, wraps or even elastic bandages. Your doctor will decide what type of compression method suits you best.

If compression therapy fails, then your doctor may prescribe you medications like Aspirin or Pentoxifylline. These drugs are very effective in the treatment of ulcers. In addition, diuretics may also be prescribed to reduce the swelling in your legs.

If you have an infection, then your doctor may prescribe you antibiotics as well to treat the infection. Take all of the medications as prescribed. Keep the area of the ulcer clean and frequently change the dressing on your leg as advised. This will reassure proper healing.  It is also important that your drink a lot of water, eat healthy, get adequate rest and exercise regularly to hasten the healing process.

Only after the wounds or abrasions heal, then compression stockings needs to be put on. This will act like a pump, compress the veins in the legs and blood will move smoothly back from the heart to the legs. This will also reduce water retention, pain and swelling in the feet to a good extent.

How to prevent ankle ulcers?

The following tips will help to prevent the development of ankle ulcers.

• Keep your leg elevated for at least 30 minutes a day for several times a day.
• Avoid standing or sitting for long periods of time. This helps to reduce the pressure and swelling that may cause venous stasis ulcers on the legs as well as help in blood circulation.
• Keep your leg elevated at night
• Check your blood pressure regularly.
• Reduce your salt intake as this will help to prevent the swelling of your legs.
• If your weight is above what you and your doctor would consider healthy, losing weight can reduce the stress placed on your legs