Diagnosis of leg ulcers
Pressure ulcers on heel and back of lower leg
A leg ulcer itself is pretty easy to diagnose. However the cause of the leg ulcer is much more difficult to diagnose.
Patients will present to doctors and nurses by themselves knowing they have a leg ulcer. Sometimes they will say that they had a cut or trauma to the skin that has just failed to heal. Other times they will have known they had discoloured or hard skin that eventually broke down leaving the ulcer.
Once the patient has got to a specialist vein clinic, they will follow the pathway as above – a full history will be taken from the patient or relatives, an examination performed of the leg and of the patient generally (including any signs of anaemia, malnutrition, other ill-health and then specifically the pulses, the skin, the movement of the joints and any signs of venous disease), and then the ulcer itself. Interestingly, examination of the ulcer itself is rarely helpful. Apart from seeing whether there is any obvious tumour, whether there is clearly infection and also whether there is a lot of tissue loss, the majority of the assessment of leg ulcers is actually the examination of the veins, arteries, movements of the joints and mobility of the patient themselves.
Once the examination has been completed, a duplex ultrasound scan is performed of the veins and arteries with or without photoplethysmography (PPG) and ankle brachial pressure indices (ABPI), the majority of cases this will lead the venous specialist to know exactly how to treat the patient.