Venous Leg Ulcers: Why Early Treatment Matters

Most people do not come in because of the ulcer. They come in because the ankle has been swollen and itchy for a year, the skin turned a rusty brown color, and then one day a small spot opened up and started weeping through their sock. That sore is a venous leg ulcer, and it is the most common kind of leg ulcer we see.

Here is the part worth knowing before you scroll any further. A venous ulcer caught in its first few weeks behaves very differently from one that has been open for a year. The early one is a wound. The old one is a chronic wound, and chronic wounds have their own biology that resists healing. That gap is the whole reason this page exists.

Medically reviewed by Dr. Timothy Horak and Julia Shauger, board-certified podiatric specialists serving Homewood, South Chicago Heights & Mokena. Last reviewed July 2026.

What a Venous Ulcer Actually Is

Veins in the leg carry blood uphill against gravity. They manage it with a series of one-way valves and with the squeeze of your calf muscle every time you take a step. When those valves fail, blood slides back down and sits in the lower leg. Pressure builds, fluid leaks out into the tissue, and the skin around the ankle slowly suffocates. The ulcer is the last step in that process, not the first.

This matters because it tells you what the treatment has to do. Cleaning and dressing the open sore treats the symptom. Getting the pressure out of the leg treats the cause.

What it usually looks like

• On the inner ankle or the lower third of the shin
• Shallow, with irregular sloping edges rather than a punched-out hole
• Wet, often soaking through dressings or socks
• Wound bed red and beefy, or covered in yellow film
• Brown or rust-stained skin around it from years of leaked blood
• Swelling that is better in the morning and worse by evening

Who tends to get them

• Anyone who has had a deep vein clot, even decades ago
• People with visible varicose veins
• Jobs spent standing, nursing, retail, factory floors
• Higher body weight, which raises pressure in the leg veins
• A previous leg fracture or leg surgery
• Older adults, and more often women than men

The brown staining is an early warning. That discoloration around the ankle shows up well before the skin opens. If you have it, you have venous disease, and compression stockings now may keep you from ever needing wound care at all.

Why Waiting Makes It Harder

A wound that stays open for months does not simply stay the same, it changes. The edges thicken and roll under so new skin cannot creep across. The wound bed fills with dead tissue and a bacterial film that ordinary cleaning will not remove. The skin around it becomes hardened and leathery, which cuts circulation to the very edge that needs to heal. None of that is present in a wound that is two weeks old.

Rolled edges

New skin cells migrate in from the rim. Once the rim hardens, that migration stalls and the wound holds its size for months.

Biofilm

Bacteria in an old wound build a protective layer. It is not the same as an infection, but it keeps healing switched off.

Skin damage

Months of drainage on the surrounding skin causes breakdown, so the wound spreads outward rather than closing inward.

How We Treat It

First: check the arteries

Before anything is wrapped around your leg we check the blood coming in, usually with pulses and an ankle-brachial index. Compression is right for a venous ulcer and dangerous for an arterial one, and the two can look similar to the eye. This step is short, painless, and it is the step that keeps treatment from doing harm.

Then: compression, which is the treatment

Compression squeezes the leg from the ankle upward, pushing pooled blood back where it belongs and dropping the pressure that opened the wound in the first place. For an active ulcer that usually means a multi-layer wrap changed in the office. Once the wound closes it means a fitted compression stocking, worn daily and long term.

• Multi-layer bandaging while the ulcer is open
• Graduated stockings for maintenance after healing
• Correct application matters, a badly applied wrap can injure the skin
• Modified or withheld if arterial circulation is poor

Alongside that: the wound itself

Debridement

Removing the dead yellow tissue and the rolled edge so live tissue can take over. Done in the office, repeated at most visits.

Dressings

Chosen for how wet the wound is. Foam or alginate for heavy drainage, and non-adhesive borders so removal does not tear fragile skin.

Skin around it

Barrier products and moisturizer for the surrounding skin, which is often the thing that decides whether the wound gets bigger or smaller.

Last: fixing the vein problem

Closing the ulcer is half the job. If the failing veins are never addressed, the same ankle tends to break down again. A duplex ultrasound maps which veins are leaking, and treatable ones can often be closed with ablation or sclerotherapy. We coordinate that with vascular specialists rather than leaving you to arrange it yourself.

What to Realistically Expect

We will not promise you a healing date before we have seen and measured the wound. What we can tell you honestly is that venous ulcers heal in weeks to months rather than days, that progress is measured by the wound getting steadily smaller from the edges inward, and that a wound which has not shrunk at all after several weeks of proper compression means something else is going on and needs another look.

The patients who do best are not the ones with the smallest wounds. They are the ones who keep the compression on, including after the skin has closed. Stopping compression once it looks better is the single most common reason a venous ulcer comes back.

Come In Sooner If

• A sore on your lower leg has not closed in two weeks
• Drainage has increased or started to smell
• The skin around the wound is hot, red and spreading

• Pain has changed from an ache to something sharp or constant
• You have diabetes and any open wound on the leg or foot
• You are running a fever alongside the wound

Common Questions

What causes venous leg ulcers?

Venous leg ulcers come from chronic venous insufficiency. The one-way valves inside the leg veins stop closing properly, so blood that should be pushed back up toward the heart pools in the lower leg instead. That standing pressure forces fluid out into the tissue, the skin around the ankle becomes waterlogged and inflamed, and eventually it breaks open. Common contributors include a previous blood clot, varicose veins, extra body weight, leg injury or surgery, and years of work spent standing.

How long does a venous leg ulcer take to heal?

It depends on how long it has been open, how big it is, and whether compression is worn consistently. A small ulcer caught within a few weeks often closes in a couple of months. One that has been open a year is a different problem and can take much longer. We will not give you a date before we have looked at the wound, measured it and checked your circulation.

Do I really have to wear compression?

For a true venous ulcer, yes. Compression is not an add-on to the dressing, it is the treatment. It counteracts the pressure inside the vein that is driving the wound. Venous ulcers rarely close without it no matter how good the dressing is, and they tend to come back if compression stops after healing. The one exception is when arterial circulation is also poor, which is why we check blood flow before applying any compression.

Can a venous leg ulcer heal on its own?

Sometimes a very small one will close on its own, but it usually reopens because the vein problem underneath has not changed. The bigger risk is that an ulcer left alone for months becomes a chronic wound with hardened edges and damaged surrounding skin, which is much harder to treat. If a sore on your lower leg has not closed in about two weeks, it should be looked at.

Get the Wound Looked At

If a sore on your lower leg has been open more than a couple of weeks, it is worth having the circulation checked before trying another dressing from the pharmacy. We see wound care patients in Homewood, Mokena and South Chicago Heights, and most major insurance is accepted.

The Sore on Your Ankle That Will Not Close