What Causes Venous Leg Ulcers and Who’s at Risk?
A small wound on your leg that won’t heal isn’t just a nuisance. It may be a sign of poor circulation and vein disease. One of the most common causes? Venous leg ulcers (VLUs).
At Hill Country Wound Care & Hyperbarics, we specialize in helping patients across San Antonio understand, treat, and prevent these painful chronic wounds. In this guide, we explain what causes VLUs, the risk factors you should know about, and how early treatment can prevent long-term complications.
What Is a Venous Leg Ulcer?
A venous leg ulcer is an open sore that typically forms on the inner lower leg or around the ankle. Unlike a scrape or cut, these wounds don’t close on their own because of underlying issues with venous circulation, the way blood flows back up your legs toward your heart.
When your veins don’t function properly, blood pools in your lower legs, causing pressure, inflammation, and eventually skin breakdown. Once a wound opens, it can become chronic without specialized medical care.
The Primary Cause: Chronic Venous Insufficiency
The root cause of venous leg ulcers is chronic venous insufficiency (CVI), a condition where the valves in your leg veins become weak or damaged.
Here's What Happens:
1. Veins are supposed to carry blood upward, against gravity.
2. One-way valves help keep blood moving in the right direction.
3. When these valves fail, blood leaks backward and collects in the lower legs.
4. This causes venous hypertension (elevated pressure inside the veins).
5. Over time, fluid leaks into surrounding tissue, damaging skin and making it prone to ulceration.
This pressure damages the small capillaries near the surface of your skin, causing the skin to become fragile, inflamed, and eventually ulcerated.
Additional Factors That Contribute to VLUs
While CVI is the main driver, other contributing factors can make someone more vulnerable to venous ulcers:
1. Swelling (Edema)
When your legs retain fluid due to poor venous return, the skin stretches, making it more prone to breakdown, even from minor trauma or scratching.
2. History of Blood Clots (DVT)
Deep vein thrombosis can damage the structure of veins and valves, increasing the risk of developing CVI and venous ulcers later on.
3. Obesity or Limited Mobility
Extra weight and sedentary lifestyles place additional pressure on the veins in your legs, slowing blood return and contributing to swelling.
4. Trauma or Injury
Even a small cut, insect bite, or bump to the lower leg can turn into a non-healing ulcer if venous circulation is impaired.
5. Infection
Once a wound opens, poor circulation makes it difficult for white blood cells and antibiotics to reach the area, leading to delayed healing or worsening infection.
Who’s Most at Risk for Venous Leg Ulcers?
Venous ulcers can happen to anyone, but they’re especially common in adults over 50 and those with a history of vein problems.
You may be at a higher risk if you have:
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A family history of vein disease or varicose veins
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A job that requires long periods of standing (e.g., nursing, teaching, retail)
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A personal history of blood clots, leg surgery, or leg injury
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Pregnancy, which puts additional pressure on the pelvic veins
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Obesity, which increases vein strain
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Smoking, which weakens blood vessel walls
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Chronic conditions like diabetes, heart disease, or kidney problems
At Hill Country, we assess your full medical history to understand your risk and design a treatment plan that supports long-term healing, not just short-term closure.
Early Signs to Watch For
Venous ulcers often begin subtly, so it’s important to recognize the warning signs before they worsen.
Look at for:
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A dull ache or heaviness in your lower legs
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Swelling that worsens throughout the day
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Brownish or reddish discoloration around the ankles
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Itchy, dry, or thickened skin
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A shallow wound that slowly enlarges instead of healing
If these symptoms appear, especially after a minor injury, it’s time to schedule a professional evaluation.
How to Prevent Venous Leg Ulcers from Coming Back
Once a VLU heals, long-term maintenance is essential. Our team works with you to prevent recurrence through:
Do:
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Elevate your legs when resting
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Stay active and walk regularly
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Wear compression stockings as prescribed
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Maintain a healthy weight
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Keep your skin clean and moisturized
Don’t:
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Smoke or use nicotine
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Sit or stand for extended periods without movement
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Expose your legs to extreme heat or cold
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Pick at scabs or dry skin
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Ignore signs of swelling or skin breakdown
How Hill Country Wound Care And Hyperbarics Can Help
At Hill Country Wound Care & Hyperbarics, we provide comprehensive care for venous ulcers and the conditions that cause them. Our experienced team uses advanced diagnostic tools, compression therapy, and state-of-the-art wound care techniques to treat not just the ulcer, but the root cause.
Our Services Include:
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Comprehensive wound assessments and circulation testing
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Compression therapy tailored to your condition
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Ultrasonic mist debridement to remove dead tissue and bacteria gently
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Cellular tissue products for wounds that aren’t responding to standard dressings
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Physician-led care with weekly monitoring and adjustment
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Three convenient San Antonio locations for easy access
If you’re at risk or showing early signs of a venous ulcer, early intervention can prevent complications, and we’re here to help every step of the way.
