What it is
When the leg veins can’t drain properly — from refluxing (leaky) valves in the superficial veins or a blockage in the deep pelvic veins — pressure builds in the lower leg. Over time that pressure damages the skin near the inner ankle until it breaks down into an open sore. In the CEAP classification of venous disease this is the most advanced stage: an active venous ulcer is C6 (a healed one is C5). Superficial Venous Disease → · Deep Venous Disease →
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A shallow, irregular open sore near the inner ankle
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Surrounding skin changes — brown discoloration, hardening (lipodermatosclerosis)
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Leg swelling, heaviness, or aching that worsens with standing
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Often recurrent, and usually less painful than an arterial ulcer
Why it matters
Venous ulcers are slow to heal and tend to come back whenever the underlying vein problem is left unaddressed. They can be painful, prone to infection, and a real drain on quality of life. The turning point is identifying the cause correctly — and confirming the arteries are healthy enough before any compression is applied.
Risk Factors
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Long-standing superficial reflux or varicose veins, especially untreated.
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A prior DVT, which scars the deep veins and drives post-thrombotic pressure →.
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Iliac vein compression, often unrecognized →.
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Obesity; prolonged standing; immobility or a fixed ankle joint, which disables the calf pump.
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Older age; prior leg ulcer — recurrence is the rule when the vein is not treated.
Diagnostic Testing
We start with a venous duplex to map reflux and check for deep obstruction, and we always check arterial flow (ABI) before any compression — compression can be harmful if there is significant artery disease. When a deep or pelvic blockage is found, IVUS confirms it from the inside.
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Venous duplex reflux study, standing →.
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Ankle-brachial index, before compression is prescribed — not after.
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IVUS when a deep or iliac blockage is suspected.
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Wound assessment and culture when infection is a question.
Treatment options
Medical & conservative therapy
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Graduated compression, once the arteries have been cleared
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Coordinated wound care and appropriate dressings →
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Elevation, walking, and skin care
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Infection management when present
Compression is the backbone of care. On its own, it treats the pressure rather than its cause, which is why ulcers so often return.
Invasive treatment
Treatment targets the underlying vein problem so the ulcer can heal — and treating the reflux early heals ulcers faster than compression alone.
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Superficial vein ablation for refluxing superficial veins
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Deep / iliac vein stenting when a pelvic or iliac outflow blockage is present — addressed first
Both are minimally invasive, through a small puncture, with same-day discharge.
Venous ulcer or a different wound?
Not every leg or foot wound is venous. A wound driven by poor arterial circulation — common in diabetes — heals only when blood flow is restored, and is managed very differently. Getting the diagnosis right is the whole point. Diabetic Foot Ulcers → · Chronic Limb-Threatening Ischemia →
When to call us — don’t wait for your next visit
A non-healing wound can change quickly. Call us right away — don’t wait for your next scheduled visit — if you notice any of these:
Call our office today if you notice:
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The wound is getting larger or deeper, or draining more
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New pain, or pain that is getting worse
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New redness, warmth, swelling, or a foul odor — possible infection
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New black or darkening tissue, or a new area of skin breaking down
Call our office at (918) 943-5303 and tell us what’s changed — we’ll get you seen sooner, because catching these early often keeps a small problem from becoming a big one.
Go to the emergency room now, or call 911, if you have:
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A foot or leg that becomes suddenly cold, pale, numb, or painful
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An infection that is spreading quickly, or a fever with a wound
Frequently asked questions
For referring providers — We welcome venous-ulcer referrals — check an ABI before compression, and refer if a wound isn't improving on conservative care. In-house duplex and IVUS let us confirm the cause before treating. Refer: (918) 943-5303 · fax (855) 312-3594.
Refer urgently: spreading cellulitis or signs of wound infection · Routinely: a venous ulcer not improving on conservative care — check an ABI before compression. Full referral guide →