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Circulation problems in legs can lead to painful open sores
Bad circulation in legs can be painful but treatable

Date published: 5/30/2010

APATIENT I'll call Mrs. Jones has the most common cardiovascular disorder in our society. But she doesn't get chest pain or shortness of breath. She hasn't had a heart attack or a stroke. She hasn't needed heart surgery or stenting of her coronary arteries.

While she is a little overweight, Mrs. Jones, 55, is not a smoker. She can walk a mile without much difficulty, and she's generally healthy. In other words, she does not fit the typical profile of a person with a cardiovascular problem.

So what's wrong with her? Mrs. Jones has a venous ulcer, a common but seldom-discussed vascular ailment.

Venous ulcers are open wounds, usually in the lower legs, that develop when the leg veins don't return blood to the heart as efficiently as they should. They can cause a significant amount of pain.

Mrs. Jones has a small opening in her skin at the level of her ankle. It's been there for a year and is somewhat painful.

Her problems began several years ago when she suffered a blood clot--deep vein thrombosis--in her leg. Since then, she has had chronic leg swelling and discoloration in her lower leg.

Then, about a year ago, she developed an area of dry skin which ultimately turned into an open sore. The sore is about 3 centimeters around and weeps clear fluid, which sometimes seeps through her bandage onto her socks and shoes.

Mrs. Jones, a teacher, said her condition worsens after long periods of standing on her feet. By the end of the day, she just wants to put her feet up and relax.

She hasn't told many people about her condition. She's somewhat embarrassed by the swelling and discoloration in her legs, and she rarely shows her legs in public.

Fortunately for people suffering venous ulcers, there are ways to lessen the pain and ultimately heal the wounds. But treatment can take time.

A VALVE PROBLEM

Venous insufficiency is the term used to describe a group of lower-extremity problems including venous stasis ulcers like Mrs. Jones'. These problems also include:

unilateral leg swelling

varicose veins--the most common kind of venous insufficiency

venous stasis dermatitis, which involves leg discoloration and dryness

lipodermatosclerosis, which is a combination of color changes and scarring in the leg.


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If you need surgery or other expertise on vein problems, here are some things to consider:

Look for a surgeon who has experience performing newer venous ablation techniques and who received formal training in vein surgery.

When getting an ultrasound, be sure it's done in a vascular lab accredited by the Intersocietal Commission for Accreditation of Vascular Laboratories.

If you need surgery for varicose veins, your surgeon should be involved in treating all types of venous problems, not just varicose veins.

If you have a leg ulcer, you may need to go to a wound care center. Learn more about the Rappahannock Wound Healing Center at marywash ingtonhealthcare.com/ser vices/wound-healing-services.

--Dr. Victor D'Addio

These symptoms indicate that you have a problem with your leg veins properly returning blood back toward your heart:

history of leg vein clots (deep vein thrombosis)

family history of varicose veins

unilateral leg swelling

skin discoloration in the ankle area

non-healing sores/wounds around the ankle

leg pain, burning, itching, heaviness after long periods of standing.

Dr. Victor D'Addio is a vascular surgeon with Virginia Interventional and Vascular Associates in Fredericksburg. He also is medical director for the Rappahannock Wound Healing Center.