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How do we identify them? How early can we identify them? And what can we do to help prevent them occurring in the first place?
Although a fully-formed Leg Ulcer is an obvious condition to diagnose and identify, it’s often far more difficult for doctors and nurses to spot the key signs of patients who are still at the early stages of heading towards ulceration. It’s all too easy to miss a golden opportunity to prevent the worst symptoms ever actually developing.
It’s always advisable to seek specialist opinion and, increasingly, people with severe varicose veins are quite correctly bypassing NHS doctors who give the old advice of “…leave them until they cause a problem”. However, there are also many people with superficial vein valve failure who present with inflammation of the skin, but because the veins have not dilated, no varicose veins can yet be seen. These people are equally at risk of ulceration and we welcome seeing them at Whiteley Clinics, precisely because it gives us the chance to prevent further serious problems with Leg Ulcers before they occur.
One of the early warning signs is a pink, red or brown patch of skin (or the appearance of shiny, hard skin) on the lower leg, just above the ankle, usually on the inner side. This is called Lipodermatosclerosis (LDS). Without treatment – or if creams or pressure stockings are incorrectly prescribed, instead of making a referral to a specialist Vascular Surgeon – this slowly deteriorates to form a dark brown staining called Haemosiderin. If left untreated for longer, white patches then appear in the skin, indicating that the skin itself is breaking down. This condition rapidly leads to ulceration.
In fact, at any stage in this process, a referral to a specialist vascular surgeon would have been likely to result in definitive treatment that would not only stop further deterioration but often manages to reverse the process.
One note of caution – if the patient is not able to trigger their own internal, natural ‘leg pumping action’ – either through an inability to walk or due to poor ankle movement – then, unfortunately, surgery is unlikely to help. There is little to be achieved by stopping the reflux that happens after blood has been pumped if no pumping effect has been generated in the first place.
So to recap, the people most likely to benefit from a Leg Ulcer assessment at Whiteley Clinics are: