Leg Ulcer Pictures
Quick answer
Leg ulcers look different depending on their cause. Venous ulcers form just above the ankle, are shallow with irregular borders, and sit in reddish-brown, swollen skin. Arterial ulcers appear on pressure points like the heels and toes, look deep and punched-out, and sit in pale, shiny, hairless skin. Neuropathic ulcers develop on the sole under the big toe, ringed by thick callus, and often cause no pain because nerve damage removes the warning signal.
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Leg ulcers are painful and persistent open sores that develop on the skin, most commonly on the lower legs. These wounds can often take a long time to heal without proper medical intervention and severely impact a person’s quality of life, especially when left untreated.
While the topic may feel uncomfortable to explore, awareness is key. Early detection and prompt care can help reduce discomfort, prevent infections, and avoid costly complications down the line. That’s why it’s so important to recognize the signs and understand the underlying causes.
At CACVI, our team of vascular health experts like those such as Dr. M. Lala, have over 30 years of experience in treating vascular conditions like leg ulcers. We’re committed to helping patients prevent long-term damage and get back to living pain-free lives. If you or a loved one suspects the presence of a leg ulcer, don’t wait. Contact us today!
In this article, we’ll explore what leg ulcers are, their causes, and how they’re treated. We’ll also include visual references (real-life images of leg ulcers) to help you recognize the condition early. While these pictures may be graphic, they play an important role in helping individuals understand the seriousness of leg ulcers and the necessity of seeking timely care.
Leg Ulcers at a Glance
The four kinds of leg ulcer differ in where they sit on the leg, how they look, and how much they hurt. Those differences are what tell you which one you are looking at.
| Type of leg ulcer | Where it appears | What it looks like | Pain |
|---|---|---|---|
| Venous ulcerChronic venous insufficiency — vein valves let blood pool in the leg | Inner lower leg, just above the ankle | Shallow, irregular borders; surrounding skin reddish-brown, swollen and hardened | Aching and itching; eases when the leg is raised |
| Arterial (ischemic) ulcerPeripheral artery disease — too little oxygenated blood reaches the skin | Pressure points: heels, toes, outer edge of the foot | Deep, punched-out appearance; pale base; skin around it shiny, hairless and cool | Often severe, worse at night and when the leg is raised |
| Neuropathic ulcerDiabetic neuropathy with reduced sensation in the feet | Weight-bearing sole of the foot, under the big toe or the ball of the foot | Round wound ringed by thick callus; often deeper than it looks | Little or none — nerve damage removes the warning signal |
| Vasculitic and other atypical ulcersAutoimmune vessel inflammation, infection, cancer or an inherited disorder | Anywhere on the lower leg, often both legs | Purple or bruised-looking patches that break down; borders vary with the cause | Variable, often tender |
What a Leg Ulcer Looks Like When It Starts
Leg ulcers rarely appear as an open sore on day one. These are the changes that come first, usually around the ankle:
- Skin colour changes. The skin around the ankle or lower leg turns red, brown or purple.
- Texture changes. The area starts to feel hard, dry or thickened rather than soft.
- Swelling. The leg swells, and the swelling worsens after long periods of standing or sitting.
- Itching or burning. Itching, tingling or a burning feeling in the same area, easy to dismiss early on.
- A wound that stalls. A cut or scrape on the leg that is not healing in a reasonable time.
Types of Leg Ulcers
Leg ulcers are more common than you might think, especially among older adults and individuals with chronic conditions like diabetes or circulatory problems. In fact, venous leg ulcers account for about 70% of all chronic leg wounds. Early identification and treatment are important, not just to ease discomfort but also to prevent serious complications such as infections, blood clots, or long-term tissue damage. Raising awareness of leg ulcers allows individuals to recognize the warning signs and seek care before the condition progresses.
There are several different types of leg ulcers, each with its own underlying cause, appearance, and treatment approach:
1. Venous Leg Ulcers
The most common type, venous leg ulcers, are a result of chronic venous insufficiency, where damaged or weakened vein valves cause blood to pool in the lower legs instead of circulating back to the heart. This pressure buildup eventually leads to skin breakdown and ulceration, typically on the inner part of the leg, just above the ankle.
A venous leg ulcer is usually shallow with irregular borders, surrounded by swollen, discolored skin, often reddish-brown due to iron buildup from leaking red blood cells. The skin may feel hardened (a condition called lipodermatosclerosis) and may be warm or itchy. Because of their origin, venous ulcers are sometimes referred to as stasis ulcers.
2. Arterial Leg Ulcers
Also known as ischemic ulcers, arterial leg ulcers develop when there is poor blood circulation through the arteries, often caused by peripheral artery disease (PAD). This type of leg injury restricts oxygen from reaching the skin tissue, causing it to die and form ulcers.
These ulcers typically appear on pressure points of the feet, like the heels, toes, or outer edges, especially in people who are immobile or wear tight shoes. They tend to be deep, have a punched-out appearance, and may be very painful, particularly at night or when the legs are elevated. The skin around the ulcer is often shiny, hairless, cool to the touch, and pale due to the lack of oxygenated blood.
3. Neuropathic Ulcers
Neuropathic leg ulcers are primarily linked to diabetic neuropathy, which is when there is nerve damage caused by uncontrolled diabetes. This damage leads to reduced sensation in the feet, making it hard for individuals to notice injuries or pressure points.
These ulcers often develop on weight-bearing areas of the feet, such as the soles or balls of the feet. Because of the lack of pain due to nerve damage, the ulcers may go unnoticed and worsen over time. They are typically surrounded by callused or thickened skin, and infections are common if left untreated.
4. Rare and Atypical Ulcers
Not all leg ulcers fall into the common categories. Some are caused by less frequent or more complex conditions, including vasculitis (inflammation of blood vessels), infections, cancerous growths, or inherited skin disorders. These ulcers can vary in size, depth, location, and appearance, depending on the root cause.
Below are a few examples of rare or atypical leg ulcers:
Vasculitic Ulcers
These are caused by autoimmune conditions that inflame the blood vessels, reducing blood flow to the skin. They often present with a purple or bruised appearance, surrounded by inflamed tissue.
Infectious Ulcers
Ulcers that develop as a result of bacterial, fungal, or parasitic infections. These may have discharge, odor, or rapidly spreading redness.
Malignant Ulcers
Skin cancers such as squamous cell carcinoma can sometimes appear as chronic, non-healing ulcers. These require biopsy and specialized treatment.
Genetic Ulcerative Disorders
Conditions like sickle cell anemia or epidermolysis bullosa can lead to skin fragility and ulcer formation, often from minor trauma.
Common Causes and Risk Factors of Leg Ulcers
Leg ulcers often result from underlying health issues that impair blood circulation, such as venous insufficiency, arterial disease, or diabetes. Other contributing factors include prolonged immobility, obesity, and certain genetic predispositions. Understanding the diverse causes and risk factors for leg ulcers is essential for effective prevention and treatment strategies.
1. Venous Insufficiency
Venous insufficiency occurs when leg veins do not effectively circulate blood to the heart. This inefficiency can lead to increased pressure in these veins, causing varicose veins. When there is increased pressure on the veins, it causes fluid to leak into surrounding skin tissue, leading to skin changes and, eventually, venous leg ulcers.
2. Arterial Disease
Arterial disease, such as atherosclerosis, results in narrowed or blocked arteries, reducing blood flow to the legs. This lack of blood flow can cause skin and tissue to break down, leading to ulcers.
3. Diabetes and Neuropathy
High blood sugar levels associated with diabetes can lead to nerve damage, particularly in the feet. This neuropathy can result in a loss of sensation, making it difficult to notice injuries or pressure spots, which can develop into ulcers.
4. Lifestyle and Other Risk Factors
Lifestyle factors such as smoking impair circulation and wound healing, increasing the risk of having a leg ulcer. Obesity can also put additional pressure on veins, leading to varicose veins and venous leg ulcers. Other risk factors include advanced age, a sedentary lifestyle, and a history of leg injuries or surgery.
Leg Ulcer Symptoms and Diagnosis
Early symptoms of a leg ulcer often start subtly, with noticeable skin changes and leg swelling. You might observe that the skin around your ankles or lower legs becomes discolored, often red, brown, or purple, and starts to feel hard, dry, or thickened. Swelling tends to worsen after long periods of standing or sitting. Some people also experience itching, tingling, or a burning sensation in the affected area, which can be easy to overlook in the early stages.
As the condition progresses, the discomfort increases. Pain may intensify, particularly around the ulcer site, and an open sore will typically form. Typically, this is a wound that heals very slowly or not at all. In some cases, there may be fluid or discharge oozing from the ulcer, and if an infection develops, it can be accompanied by a foul odor, increased redness, and even more pronounced swelling and tenderness around the wound.
To diagnose leg ulcers, a healthcare professional examines the leg and ulcer, noting the size, depth, and location of the ulcer and any signs of infection. They also review the patient’s medical history.
In some cases, a tissue sample from the ulcer may be taken to check for dead tissue or rule out the ulcer. This process is called a Biopsy. Some diagnostic procedures include blood tests and imaging tests.
When Should You Seek Medical Help for Leg Ulcers?
If you notice persistent symptoms like leg swelling, changes in skin color or texture, or areas of the skin that feel unusually warm or cool, seek medical advice. We also recommend reaching out to a vascular professional for any unexplained leg pain or discomfort, especially if it worsens when you walk.
You should also be cautious when you notice any cuts, scrapes, or wounds on the legs that do not heal within a reasonable timeframe. Noticeable changes in the veins in your legs, such as new varicose veins or veins that become more prominent, could also be a red flag.
You should consult a healthcare provider if you experience persistent leg swelling, changes in skin color or texture, or if any area of the leg feels unusually warm, cool, or tender to the touch. It’s also important to speak with a vascular specialist if you’re dealing with unexplained leg pain, especially if the discomfort worsens while walking or standing for long periods.
Be especially cautious if you notice wounds on the legs that do not heal within a reasonable timeframe. These could be early signs of a venous ulcer or stasis ulcer. Additionally, any sudden changes in your leg veins, such as the appearance of new varicose veins or veins that become more prominent and twisted, may indicate underlying circulatory issues that warrant medical attention.
Leg Ulcers – Treatment Options
Do ulcers heal? Leg ulcers rarely heal on their own. In fact, without proper care, they can easily become infected and worsen over time. That’s why medical treatment is not just recommended, but essential. Prompt and professional care significantly increases the chances of healing and reduces the risk of long-term complications, including tissue damage or even amputation.
Treatment often begins with regular and thorough cleaning and dressing of the ulcer. This is done to prevent infection, promote healing, and remove dead skin or tissue that can impede recovery. These dressings are typically changed by a healthcare professional, especially in the early stages, and may be paired with specialized wound care products designed to support skin regeneration.
Doctors may also prescribe topical or oral antibiotics if there’s an infection, pain medications to manage discomfort, or circulatory medications to improve blood flow in the legs. In many cases, particularly with venous ulcers, compression therapy using compression stockings is a key part of treatment. This helps reduce swelling, support vein function, and prevent blood from pooling in the lower legs.
In more advanced or non-healing cases, surgical intervention may be necessary. This could include debridement (removal of infected or dead tissue), skin grafting, or procedures to repair or remove damaged veins.
Alongside medical care, lifestyle changes can play a major role in supporting recovery and preventing new ulcers from forming. For instance, a balanced diet rich in vitamins and minerals, especially vitamin C and zinc, can help the body rebuild damaged tissue and boost immune function.
Gentle exercise, like walking, can stimulate circulation, but it’s important not to overdo it, especially if you’re dealing with varicose veins or ongoing pain. Weight loss can also significantly reduce the pressure on your legs and veins, easing the burden on your circulatory system.
Another helpful habit is elevating your legs above heart level for short periods throughout the day. This simple action can reduce swelling, alleviate discomfort, and support venous return, which is especially important for preventing and managing stasis ulcers and venous ulcers.
Worried About Your Leg Ulcers?
Leg ulcers are open wounds that typically develop on the lower legs, often as a result of poor circulation. Common early signs include changes in skin color or texture, persistent pain, swelling, and eventually, the appearance of a non-healing sore. Catching these symptoms early is key to effective treatment and avoiding complications.
When it comes to managing and preventing leg ulcers, a whole-body approach is essential. This includes maintaining a balanced diet rich in vitamins and nutrients, engaging in regular low-impact exercise to boost circulation, quitting smoking, and staying on top of chronic conditions like diabetes or high blood pressure. Regular self-inspections of your legs, especially if you’re at higher risk, along with prompt medical attention when symptoms arise, can make a significant difference in outcomes.
At CACVI, we specialize in vascular health and provide thorough evaluations and personalized treatment plans tailored to each patient’s unique needs. If you’re concerned about a leg injury, venous ulcer, or symptoms like swelling or skin changes, don’t wait. Contact us today to schedule your consultation and take the first step toward healing.
✓ Medically reviewed by
Dr. Vasim Lala
D.O., FACC, FSCAI, RPVI · Coronary, vascular and structural intervention
Trained at Mount Sinai in New York in advanced coronary, vascular and structural intervention. Focuses on minimally invasive heart and vascular procedures and on preventive cardiology, and writes for the American College of Cardiology.
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