A varicose ulcer is an open wound on the lower leg caused by poor blood flow in the veins. It typically develops near the ankle when damaged or weakened veins can’t push blood back up to the heart efficiently, leading to a buildup of pressure that eventually breaks down the skin. These ulcers are also called venous leg ulcers or venous stasis ulcers, and they account for the majority of all chronic leg wounds.
They tend to be shallow, irregularly shaped sores that can persist for weeks, months, or even years. Even with proper treatment, only about 50 to 60 percent heal completely within six months.
How Varicose Ulcers Form
Veins in your legs contain one-way valves that keep blood flowing upward toward the heart. When those valves weaken or fail, blood pools in the lower leg. This creates sustained high pressure inside the veins, a condition called venous hypertension.
That pressure forces red blood cells and large protein molecules to leak out of the veins and into the surrounding skin tissue. As red blood cells break down, they release iron, which triggers a chronic inflammatory response. White blood cells flood into the skin and release inflammatory signals that, over time, change the way the skin’s structural cells behave. Instead of repairing tissue normally, these cells become locked in a cycle of tension and destruction. The iron overload also keeps immune cells stuck in an attack mode rather than shifting into a repair mode. The result is skin that progressively thins, hardens, and eventually opens into a wound that struggles to heal on its own.
What a Varicose Ulcer Looks Like
Most varicose ulcers appear on the inner side of the leg, just above the ankle. They’re typically shallow with a red wound bed, sometimes covered by a layer of yellow tissue. The borders are uneven and sloping rather than sharply defined. The skin around the ulcer often looks discolored, turning reddish-brown or dark from iron deposits beneath the surface, and it may feel hard or leathery to the touch.
Heavy fluid drainage from the wound is common and can cause a noticeable odor, which often leads to social embarrassment and emotional distress on top of the physical discomfort. Pain levels vary. Some varicose ulcers cause only mild aching, while others become significantly painful if swelling or infection develops. The discomfort often worsens when standing and improves with leg elevation.
How They Differ From Arterial Ulcers
Not all leg ulcers come from vein problems. Arterial ulcers form when arteries can’t deliver enough blood to the lower leg, and they look and behave quite differently. Arterial ulcers have sharply “punched out” edges, tend to appear on the feet or toes, and are painful even without infection. You may also notice weak or absent pulses in your foot. Varicose ulcers, by contrast, have sloping edges, sit near the ankle, and are generally less painful unless complications arise. This distinction matters because the treatments are different, and compression therapy (the standard treatment for varicose ulcers) can actually be harmful when arterial disease is the underlying cause.
Who Is Most at Risk
Varicose ulcers tend to develop in people who already have visible varicose veins, a history of blood clots in the deep leg veins, or prior leg injuries that damaged the venous system. Age is a significant factor, as vein valves naturally weaken over time. Obesity increases the pressure on leg veins and slows healing. Prolonged standing, limited mobility, and previous ulcers all raise the risk further. Once you’ve had one varicose ulcer, the chance of developing another is substantial.
Compression Therapy: The Primary Treatment
The cornerstone of varicose ulcer treatment is compression. Specially designed bandages or stockings apply firm, graduated pressure to the lower leg, typically in the range of 30 to 40 mmHg at the ankle. This external pressure counteracts the venous hypertension that caused the ulcer in the first place, helping blood flow back upward and reducing the fluid leaking into surrounding tissue.
Compression works, but it requires patience and consistency. In one study of 232 patients receiving good compression therapy, only 60 percent achieved complete healing within 20 weeks. Broader reviews have found total healing rates ranging from 29 to 81 percent at 24 weeks, depending on the size and age of the wound when treatment starts. Larger, older ulcers take significantly longer to close, and some remain open for years despite treatment.
You’ll typically have your bandages changed by a nurse or wound care specialist on a regular schedule. The wound is cleaned and dressed, then rewrapped with compression. Once the ulcer heals, wearing compression stockings long-term is essential to prevent recurrence.
Treating the Underlying Vein Problem
Compression manages the symptoms, but it doesn’t fix the damaged veins. Procedures that close off or remove the faulty veins can address the root cause and significantly reduce the chance of the ulcer coming back.
A large clinical trial of 450 patients (the EVRA trial) found that early treatment of the underlying veins alongside compression therapy accelerated ulcer healing compared to compression alone. More importantly, at three years of follow-up, the recurrence rate was about 25 percent in the group that had early vein treatment versus 30 percent in the group that waited. An earlier study found an even more dramatic difference: without vein surgery, 56 percent of ulcers recurred within four years, compared to 31 percent in patients who had the procedure.
These procedures are typically minimally invasive, performed through small needle punctures rather than open surgery, and most people go home the same day.
Signs of Infection
Because varicose ulcers are open wounds that can persist for long periods, infection is a real concern. Warning signs include new or worsening pain around the ulcer, redness and warmth spreading outward from the wound edges, tenderness, and a foul smell. Heavy, discolored discharge is another red flag. If the infection spreads beyond the wound itself, you may develop fever and chills. An infected ulcer needs prompt evaluation because untreated infection can delay healing further and, in serious cases, spread to deeper tissues.
Living With a Varicose Ulcer
The physical and emotional toll of a varicose ulcer is often underestimated. These wounds can take months to heal, require regular clinic visits for dressing changes, and limit your activity. Odor from wound drainage can cause people to withdraw socially, leading to isolation and depression. Sleep disruption from pain or discomfort is common.
A few practical habits make a meaningful difference during healing. Elevating your legs above heart level for 30 minutes several times a day helps reduce swelling and supports blood return. Staying as mobile as possible, even with short walks, activates the calf muscle pump that assists venous flow. Keeping the skin around the wound moisturized prevents further breakdown. And wearing your compression stockings consistently after healing remains the single most effective step you can take to keep the ulcer from returning.