Venous Leg Ulcers: Causes, Warning Signs, and Treatment for New York Patients

Venous leg ulcers are open wounds that develop on the lower leg, usually near the ankle, when chronic venous insufficiency progresses far enough to break down the skin. They are the most advanced visible complication of vein disease and, in published wound-care research, account for the large majority of chronic leg ulcers seen in clinical practice. For New York patients managing long-standing varicose veins or venous insufficiency, understanding venous leg ulcers — how they develop, what the earliest warning signs look like, and when to seek care — can make an important difference in preventing one or catching it early.

At Schulman Vein and Laser Center, our physicians evaluate patients with visible skin changes, chronic swelling, or slow-healing wounds on the lower leg as part of our comprehensive vein disorders and conditions care. This guide explains what causes venous leg ulcers, the warning signs to watch for, and how a physician-led evaluation can support both healing and prevention of recurrence.

Venous leg ulcers develop as a result of sustained venous hypertension — persistently elevated pressure inside the leg veins caused by faulty vein valves that allow blood to pool instead of returning efficiently to the heart. Over months or years, this elevated pressure damages the smallest blood vessels in the skin, triggers ongoing inflammation, and gradually breaks down tissue until an open wound forms, most often over the inner ankle.

This process is the natural progression of untreated or undertreated chronic venous insufficiency, the same underlying condition responsible for varicose veins, chronic leg swelling, and skin changes like stasis dermatitis. Recognized risk factors include a long history of untreated varicose veins, prior deep vein thrombosis, obesity, prolonged standing occupations, and a family history of vein disease.

Venous leg ulcers rarely appear without warning. In the months or years beforehand, the skin on the lower leg typically shows a recognizable pattern of change that reflects worsening venous insufficiency.

When a venous leg ulcer does form, it typically appears over the inner ankle as a shallow wound with an irregular shape and uneven edges. The skin surrounding the ulcer often looks shiny or stretched thin, may feel warmer than the surrounding skin, and the wound itself is usually painful and may ooze or bleed.

These features distinguish venous leg ulcers from other types of chronic wounds, such as arterial ulcers (which tend to be smaller, deeper, and located on the toes or foot) or diabetic ulcers (which typically form over pressure points on the sole). Because treatment differs by ulcer type, an accurate diagnosis matters before starting compression therapy or wound care.

Venous leg ulcers do not heal on their own, and a wound that lingers creates an ongoing risk of infection. If an ulcer does not show improvement within a few weeks of starting care, or shows signs of infection, prompt medical evaluation is important to prevent more serious complications.

Diagnosis begins with a physical examination and a review of your vein disease history, followed by two key tests. An ankle-brachial index (ABI) test compares blood pressure at the ankle and arm to rule out significant arterial disease, since compression therapy — the standard treatment for venous ulcers — can be unsafe if arterial blood flow is compromised. Duplex ultrasound then maps the venous system to confirm reflux and identify which veins are contributing to the elevated pressure.

Once arterial disease is ruled out, compression therapy is the recognized first-line treatment for venous leg ulcers: specialized bandaging or garments apply graduated pressure to counteract venous hypertension and support healing. Wound care — cleaning, dressing changes, and infection monitoring — proceeds alongside compression. Many patients also benefit from treating the underlying venous reflux directly, using approaches such as radiofrequency ablation or laser vein therapy for the diseased vein feeding the ulcer, which published research associates with faster healing and fewer recurrences than compression alone.

Venous leg ulcers have a well-documented tendency to return, which is why ongoing management matters even after a wound has fully healed. Patients who complete treatment of their underlying varicose vein treatment and continue wearing properly fitted compression stockings, as outlined in our guide to compression stockings and vein health, significantly reduce their risk of a new ulcer forming.

If you notice skin changes, chronic swelling, or a slow-healing wound on your lower leg, do not wait for it to worsen. Schulman Vein and Laser Center provides physician-led evaluations, including duplex ultrasound, at three New York locations serving Manhattan, Nassau County, and Suffolk County.

Book a Free Vein Screening to have your legs evaluated. Call Manhattan at 212.987.0500, Manhasset at 516.482.4477, or Commack at 631.543.4599. If you already have an open wound with signs of infection, contact your physician or seek urgent care promptly rather than waiting for a scheduled screening. This article is educational and does not replace an in-person medical evaluation.