Compression treatment and elevation for venous skin ulcers

Venous skin ulcers develop when the lower leg veins and calf muscles are weakened and cannot efficiently move the blood back toward the heart. Pooled blood and fluid in the lower legs then leads to tissue breakdown. You can prevent or heal a venous skin ulcer by helping your blood circulate back toward your heart.

Leg elevation

During sleep. While you are sleeping, you can help your blood circulate back to your heart by elevating your feet above the level of your heart. Prop the foot end of your bed up on 6 in. (15.24 cm) to 8 in. (20.32 cm) blocks.

While awake. During waking hours, try to elevate your legs above the level of your heart for 30 minutes, 3 to 4 times a day.

Elevating your legs may be all the treatment you need if you have mild venous insufficiency. But if you continue to have problems with venous skin ulcers, you will need additional treatment.

Exercise

Doing regular foot and ankle exercises can help strengthen your leg muscles and improve blood flow in your legs. While you are sitting (or standing), flex your ankles by pointing your toes away from you and then pointing them up. Do 10 repeats of the exercise several times each day. This exercise is especially important for people who need to sit or stand for long periods of time.

Walking is also good exercise for improving blood flow in the legs.

Compression

Compression therapy is the main treatment for venous skin ulcer. If you develop a venous skin ulcer, your health professional may first want to reduce the buildup of fluid in your lower leg. There are several types of medical devices for compression therapy.¹ If you have an open wound, it will be covered with a dressing before the compression device is applied.

Unna boot. This is a stiff bandage made with gauze and zinc oxide paste wrapped around the lower leg. This type of bandage improves blood flow by putting greater pressure on leg muscles when they are flexing and less pressure on the leg during rest. It is used to reduce a large amount of swelling in your lower legs. An Unna boot can be left on for 7 to 10 days. This bandage is seldom used now because it is hard to apply. But a less rigid Unna boot, called a short-stretch bandage, may be wrapped around the lower leg.

Long-stretch bandage. This is a flexible bandage that is wrapped tightly around the lower leg to reduce swelling and improve blood flow. The bandages can be hard to put on properly and usually are used to help heal a venous ulcer. The ulcer is covered with a dressing before the bandage is put on.

Active compression device. This type of device goes around your lower leg. It has air bags that inflate and deflate periodically to force blood to flow out of your lower leg toward your heart. This type of device usually is used to help heal a venous ulcer that has not been helped by other types of treatment.

Compression stockings. Once your lower-leg swelling has been reduced, compression is used to create more constant pressure on both the flexing and resting leg muscles. The most common device for helping blood flow through the lower legs is a pair of compression stockings. You should wear these stockings every day from the time you wake up until you go to bed. They can help venous skin ulcers heal and help prevent them from coming back. See a picture of how to put on a compression stocking.