Diagnosing a venous leg ulcer

See your GP if youthink youhave a venous leg ulcer. The ulcer is unlikely toheal without specialist treatment.

Diagnosis is largely based on your symptoms and examination of your affected leg, although additional tests may be required.

Medical history and examination

Your GP or practice nurse will ask whether you have any other symptoms associated with venous leg ulcers, such as:

• swelling in your ankles
• discoloured or hard skin

They'll try to determine the cause of the ulcer by asking about underlying conditions or previous injuries, such as:

• diabetes
• deep vein thrombosis (DVT)
• injury or surgery in the affected leg
• a previous leg ulcer

They'll also examine your leg, both when you're standing up and lying down. Varicose veins will be more obvious when you're standing up, and it will be easier to look at the ulcer when you're lying down.

They'll also feel your pulse at your ankles to make sure the arteries in your leg are working properly.

Doppler study

To rule out peripheral arterial disease (acondition affecting the arteries) as apossible cause of your symptoms, your GP or nurse will carry out a test known as a Doppler study.

The involves measuring the blood pressure in the arteries at your ankles and comparing itto the pressure in your arms.If you have peripheral arterial disease, the blood pressure in your ankles will be lower than your arms.

It's important to carry out this check as the main treatment for venous ulcers is compression bandages or stockings to improve thevein circulation in your legs. It's not safe to apply compression if the ankle artery pressures are low.

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Referral to a specialist

In some cases, your GP or nurse may decide to refer you toa specialist in conditions affecting the blood vessels (vascular specialist).

For example, you may be referred to a vascular specialist if your GP or nurse is unsure about your diagnosis, or if they suspect your ulcer may be caused by artery diseases, diabetesor rheumatoid arthritis .

After taking your medical history and examining you, the vascular specialist may need to arrange further investigations to plan your treatment.