Use this search box to search our site

venous stasis ulcer

AUTHOR: Marc Mitnick DPM

REVIEWED BY: Podiatric Medical Review Board

--> venous stasis ulcer


An ulcer, as it relates to skin, is defined as a discontinuity in the normal layers that make up the skin, thus leaving a void. There are different types of ulcers but this discussion will be limited to venous stasis ulcers.

It is estimated that venous stasis ulcers affect 500-600,000 people in the United States every year and it is by far the most common type of leg ulcer seen.

This type of ulcer accounts for the loss of 2 million working days and incurs treatment costs closing in on $3 billion dollars per year in the USA.


  • Venous stasis ulcers are a result of a poor functioning venous system. In other words the veins of the legs are not properly pumping blood back to the heart.
  • These types of ulcers are common in people who have a history of leg and feet swelling.
  • The liklihood of developing a venous stasis ulcer increases with age.
  • The causes may be from varicose veins as a result of pregnancy, obesity or hereditary factors.
  • A history of blood clots (phlebitis)
  • A history of trauma to the lower leg. Although I do not have hard statistics, I would say that in my practice, trauma is the number one source of venous stasis ulceration.
  • Inflammatory diseases such as vasculitis, lupus, scleroderma or other rheumatological disease states can help create venous insufficiency (poor venous function)
  • Diminished skin texture, or thinning of the skin, which may then lead to venous stasis ulcers.
  • Infections
  • Malignancies can also be a source of these types of ulcer formation
  • A history of sitting or lying in one position too long may also precipitate the formation of a venous ulcer.
  • Parapalegics may also develop these types of ulcers due to the lack of pumping ability in their calf muscles.

These types of ulcers are found on the inner part of the lower leg usually just above the ankle. They can occur either on one or both legs and each leg may have more than one ulceration.

signs and symptoms of venous stasis ulcers

SYMPTOMS- may include mild to severe edema of the foot, ankle and lower leg as well as sensations of fatigue and heaviness with burning or itching. Simple elevation of the leg for an hour at at time will bring much pain relief to most people. There may also be a rash, redness, brown discoloration which is known as hemosiderin deposits which is nothing more then blood seeping into the skin and staining it.

APPEARANCE- The ulcer usually presents itself as an open sore in an area that already typically exhibits a red to brown discoloration that has probably been present for some time. The area will also be swollen. Prior to the formation of the ulceration the skin may have also been somewhat flaky and itchy as well. This pre-ulceration condition is known as stasis dermatitis which is an eczema of the skin as a result of blood perfusing through and settling into the layers of skin, breaking down and depositing hemosiderin and melanin, as a result of the venous system’s inability to adequately pump it up to the heart.

The base of the ulcer is usually red, but overlying the base there may be a white to yellow tissue that is known as fibrous tissue which is basically a type of scar tissue that does not promote healing. There may be a clear to yellow drainage coming from the wound. This can occur without the ulcer being infected, however, if the wound is infected there generally will be larger amounts of drainage coming from the wound and the surrounding area will be much more red in color than normal (normal including those with stasis dermatitis). Antibiotics are not routinely administered unless the wound is grossly infected. What may appear as an infection to the layperson will be nothing more than inflammation to the experienced doctor.

Note the picture below. There are actually two small venous stasis ulcers present, noted by the blue arrows. Also evident is yellow fibrous tissue.venous stasis ulcer


COMPRESSION- venous stasis ulcers are treated through compression of the affected leg to minimize swelling. If you do not eliminate the constant swelling you dramatically reduce the likelihood of closing the wound. People with varicose veins will notice that their feet and ankles are generally normal in size in the morning only to get progressively more swollen as the day goes on. For this reason it is important to have a dressing change with fresh compression in the morning in an effort to not allow the foot and leg to swell during the course of the day. As a side note, many people, particularly the elderly will develop venous stasis ulcers from nothing more than sitting all day with their feet in a dependent position. This coupled by the fact that depending on the type of chair they are sitting on, they may be cutting off the return circulation of the veins behind the thigh thus further exacerbating the problem. Add to this the fact that many elderly also have poor arterial circulation, their skin will become very thin (onion like) and the slightest trauma to the area, including just scratching the area will precipitate the formation of an ulcer.

Compression of the affected limb may include compression stockings, ace bandage or similar multilayer compression wraps or even an unna boot which is a compression dressing containing zinc oxide, calamine lotion, glycerin and gelatin that not only reduces swelling but also helps heal the ulcer. It is very important to note that many people with venous stasis ulcers also suffer from arterial insufficiency. In those individuals excessive compression therapy is not indicated as it will further impede blood flow down to the foot.

Although compression therapy has been the gold standard, there are some individuals that cannot tolerate compression over the ulcer; it just hurts too much. In recent years a drug call pentoxifylline (Trental) has been used with a reasonable amount of success. Pentoxifylline's original indication was for arterial insufficiency or poor blood flow down to the feet. It is thought that the drug works in a couple of ways. One, it improves the circulation down to the feet which in essence would improve the ability of the body to heal itself by bringing more nutrients to the site of the ulcer. Two, it may also improve the actual wound environment of the stasis ulcer so that it will heal quicker.

This therapy may be combined with compression therapy or may be used alone in those individuals who cannot tolerate compression. In studies it was found that a higher than usual dosage of pentoxifylline was more effective in closing this type of ulcer.

CARE OF THE WOUND- the ulcer itself generally has to be treated in an effort to remove all devitalized tissue and to promote formation of healthy granulating tissue. Debridement or removal of this dead tissue may be done in a couple of different ways. The most common is through sharp debridement where your doctor takes a scalpel and scrapes away all dead tissue within the ulcer and immediately surrounding the wound. The problem with this is that it can be a painful procedure and at times may have to be done under local anesthesia.

Other techniques include mechanical debridement using modalities such as wet to dry dressings , hydrotherapy and wound irrigation where the action of water against the wound helps remove the dead tissue. We also have available to us what is known as enzymatic debridment where through the use of topical ointments we can remove dead tissue. In this day and age we now have wound dressings which also have the capability of help remove debris from the wound.

Dead tissue has to be removed for two reasons, one it harbors bacteria so if the wound is already infected it helps clear up the infection and if the wound is not yet infected it greatly reduces the possibility of infection. Secondly, healthy tissue cannot form where there is an abundance of dead tissue so healing will be delayed.

Of all the types of debridement methods available I feel the use of the scalpel is the most effective. It allows the doctor to remove exactly what he wants and does so much more effectively than other methods. The only time an ulcer does not have to be debrided is when a dry scab (eschar) has formed over the ulcer. The eschar acts as a protective barrier and greatly reduces the chance of infection.

The type of dressing that goes under the compression dressing will be at the discretion of your doctor. One thing there is no shortage of these days are wound care dressings. The type used on your wound will be the one your doctor has had the most success with.

venous stasis ulcer treatment precautions

Treating an ulcer is not like treating a “cut”. You have to be very careful of what you place on the wound. An ulcer is a result of devitalization to the tissue and applying certain topical ointments, creams and liquids may actually do more damage. Things like alcohol, witch hazel, betadine amongst others will actually make the wound worse.

Venous stasis ulcers may take a long time to heal. Healing rates can be poor with up to 50 percent of venous ulcers open and unhealed for nine months or longer. Factors such as the degree of venous insufficiency, the size of the ulcer, the severity of the surrounding stasis dermatitis, a history of phlebitis, smoking, obesity and not properly following your doctor’s orders will all prolong the healing time. In certain instances ulcers that are taking excessively long to heal should be biopsied to rule out malignancy or vasculitis.

Once healed, if the underlying problem is not resolved or at least controlled, there is a very high incidence of recurrence. Venous stasis ulcer recurrence rates occur in one third of treated individuals with some experiencing four or more episodes of ulceration. This would include regular use of compression stockings as well as lotions to keep the skin hydrated. Additionally, accompanying disease states and bad habits also have to be resolved.

Other things that can be done to avoid venous stasis ulcers in those predisposed to the problem include:

  • wash feet daily, dry well and observe for any changes in skin color or appearance
  • maintain physical activity
  • stop smoking
  • eat a well balanced heart healthy diet which will help reduce blood pressure, cholesterol levels and blood sugars.


Cleveland Clinic


Johns Hopkins Medicine

translate page

ORTHOTICS for multiple types of foot pain
best buy in a pre-made orthotic
click link below


ORTHOTICS for heel and arch pain for those who must wear dress shoes
click link below


I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis. Jennifer

Hunterville, NC
….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!


I am really, really impressed with your plain-speak explanations for the various conditions.


This was an extremely helpful site. I have an appointment on the 18th and your info. Was right on target…..


A well organized site containing much information written in a manner that the average reader can comprehend.


Ontario, Canada
I found your website and articles most interesting.


Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.


(location unknown)
I came to your website, via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.


New York
You have an amazing and extremely informative site. I enjoyed looking through all of the data and stats.


Memphis, TN
Thanks again so much for the information in the article. Very interesting.


Great article. I have had plantar fasciitis since I was in high school……..

J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Thanks for the Response, you hit it on the head.


Redondo Beach, CA
Thank you for your time and expertise in answering my question…..


(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….


(location unknown)
First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.

Pete M.

(location unknown)
Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....


Denison, TX
Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,


West lafayette, IN
Dear doubt you get positive comments re your site...May I please be added to the list of your admirers. In all of my years of web surfing I would say your site is right there with the very best. Thank you for taking the time to write the terrific info you provide and for putting things into laymen terms for us mere mortals. I pray you have much on going success and thank you again for a deed well done. As for me I did not find much help for my symptoms and will continue on my quest. Were you anywhere in the South I would make and appointment...Thanks again dear sir...m.e.

Michael E.

Tampa, Florida 33624
Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....


Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624

Thanks for a most interesting website, which has helped a lot.



Dear Dr.Mitnick

I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.

I thank you for putting together this incredible website.


Dragica W.


....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!


South Africa

You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT

First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.


Placentia, California

First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)


Unknown location

I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location

I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA

I used to work for a podiatrist (front desk) back during summers in college years ago, so I know the benefits of good care. Again, I want to thank you for an EXCELLENT website. It was so great to get to your site (top of google search) and actually find all the answers I needed EASILY and QUICKLY! Clearly you put a ton of work into it and I really appreciate it.

All the best,


Alameda, California

By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!


Thank you for your very interesting and informative site!


Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN

Thanks very much for the wonderful informative site.


New Zealand

Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!



Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

I searched the internet everywhere for a clear description and illustration of my symptoms/problem. was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

1st of all THANKS A LOT for your great site......


Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!


South Carolina
Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....


unknown location

...Thanks for your fantastic service.


Arlington, VA

Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA

Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!


location unknown

Great insights! Thanks Doc, you're the best.


location unknown

I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.


location unknown

Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.


Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!


Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.



Thanks for taking time to read and answer so many questions. It is truly a public service!


Seattle, WA

I just wanted to say that I am very greatful for this website!!


location unknown

Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.


New Jersey

Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.


location unknown

Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.


location unknown

Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!


Evansville, IA

Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

location unknown

Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.


location unknown

Thank you very much for the information, I will consider it. Excellent web site.


San Diego, CA

Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!


Albany, NY

Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown



Whichita, KS

thanks again, this site is very helpful.


Boston, MA

Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.



Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.



Wonderful advice

by: Anonymous

This is the best site for foot problem info.

Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......


location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!


Thank you for your response. You have provided some great insight (to my question)....


location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!


North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...


location unknown

Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.


New Jersey

Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown

I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!


Lenoir, NC

Thank you so much Doc for a quick and thorough response!


Bellevue, WA

I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!


location unknown

Recent Articles

  1. Vitamin D impact on health

    Feb 06, 23 07:17 PM

    Researchers are suggesting that the effectiveness of Vitamin D in fighting and preventing disease is predicated on a persons body mass index (BMI). The thinner the person the greater the positive impa…

    Read More

  2. Foods to speed up healing

    Feb 01, 23 02:41 PM

    One of the best ways to help yourself heal faster after surgery is to eat well. Getting the proper nutrition will provide your body with the essentials it needs to promote healing. Here is a suggestio…

    Read More

  3. Cancer and Type 2 Diabetes

    Jan 25, 23 04:52 PM

    An article revealing that older type 2 diabetics have a higher incidence of cancer then non-diabetics. It is suggested that cancer may surpass CVD as the number one cause of death in older diabetics.

    Read More

  4. Does glucosamine or MSM reduce arthritis pain?

    Jan 22, 23 01:41 PM

    A good review of the possible benefits to taking glucosamine, chondroitin or MSM for arthritis. Always beware of the possible side effects of over the counter supplements.

    Read More

  5. shin splints

    Jan 18, 23 05:12 PM

    A great review on the various causes of shin splints, along with treatment options.

    Read More

  6. Whats new in skin cancer?

    Jan 15, 23 08:32 PM

    A presentation of newer skin protection combinations in an effort to better protect the skin from the hazards of sun exposure.

    Read More

  7. Causes and risk factors of warts

    Jan 14, 23 05:02 PM

    A good review of the causes of warts and protective measures you can take to prevent developing them.

    Read More

  8. Do chronic wounds need to be dressed daily?

    Jan 11, 23 02:18 PM

    Because of supply chain shortages as well as staffing shortages particularly during the pandemic, many institutions extended the time between dressing changes for chronic wounds. Is this really the be…

    Read More

  9. Food choices that raise your risk of type 2 diabetes

    Jan 08, 23 10:07 AM

    A good review of how blood sugars can become elevated and the harm that can do. Certain food groups have a tendency to raise your blood sugars and should be avoided.

    Read More

  10. Outcome stats from Scarf bunionectomy

    Jan 03, 23 03:04 PM

    The Journal of Foot and Ankle Surgery recently reported a meta analysis of outcomes in 1583 Scarf bunionectomies that met their inclusion criteria. Adverse events did not seem to be any better or wors…

    Read More