Leg Pain & Ulcer Treatment

Ulcers are wounds, mainly common to the legs, ankles and feet that occur spontaneously or more frequently after minor trauma such as a new pair of ill-fitting shoes. Unfortunately, leg ulcers are a common problem that Mr Ponosh sees and they are a very serious condition. They are deep wounds with areas of skin and tissue loss that do not heal quickly or only deteriorate. Ulcers can persist for weeks or more and can cause significant pain in the legs or when walking.

Common Causes of Ulcers

There are many causes of ulcers that can result in wounds spontaneously occurring or worsen a minor injury and they include:

  • Chronic Venous Hypertension and Varicose Veins (see specific information page)
    • High pressure in the veins caused by malfunction valves causes leakage of fluid and inflammatory cells which cause tissue damage and ulcers.
  • Peripheral Arterial Disease
    • Poor arterial blood supply causes poor healing and ulceration.
  • Skin Cancers
    • Undiagnosed skin cancers can ulcerate as they get larger.
  • Infection
  • Diabetes and other conditions affecting skin sensation such as neuropathy
    • Impairs sensation so injury and trauma are more likely; increased risk of peripheral arterial disease reducing healing potential and creates environment for nastier complicated infections.
  • Trauma
  • Autoimmune conditions (eg. Rheumatoid Arthritis or Lupus)
    • Cause fragile skin with lower healing potential.

How Can Ulcers Appear

Ulcers most commonly present as an area of skin and tissue loss, which may be small, or in some cases, which have been left untreated, may be quite large. They can occur at areas of trauma such as the leg, shin, or heel/toes after wearing ill-fitting shoes. They can spontaneously occur over the ankles and on/in between your toes.

Ulcers may cause significant leg pain when walking, however in some cases (especially if you are diabetic) they may be pain free and go completely unnoticed. They may become infected with red, hot and swollen skin around them. If they progress, underlying bone and tendons can be exposed which is a very serious problem.

Ulcers can often be ignored and under appreciated by medical practitioners, however they should never be. Ulcers should always be seen and managed by an expert such as Mr Ponosh. Most small ulcers are relatively straightforward to fix but, if they are large or complicated, they can take months to heel and are more challenging.

All ulcers with a known cause, presumed cause or risk factor or, persisting for more than 2-3 weeks should be referred to a specialist wound service. With vast experience in managing ulcers, it is an area of particular interest to  Mr Ponosh and he has a long history as a Senior Consultant to the Sir Charles Gairdner Foot & Leg Ulcer Clinic.

What if I Don’t Have My Chronic Ulcers Treated?

Ulcers in most people with underlying causes will never heal by themselves. Left untreated, they will often progress and place you at risk of severe infection or even blood poisoning (septicaemia). Chronic ulcers, including leg ulcers can cause you to feel chronic leg pain, feel chronically ill and tired and may get in the way of your quality of life.

Ulcers may also prevent you from being able to have other operations such as hip or knee replacements. Most concerningly, as these ulcers progress and expose tendon or bone, they may put your toes or foot at risk.

Seeing Mr Ponosh For Leg Ulcers

If you are experiencing leg pain, pain when walking or you suspect you may have an ulcer, please consult your GP. Your GP may then contact Mr Ponosh’s office directly and in some cases, they will provide you a referral to contact the office yourself. Mr Ponosh’s caring and helpful team will walk you through the process of making an appointment and they may also contact you directly for further details. See here for more information regarding referrals.

At your appointment, Mr Ponosh will undertake a full history and appropriate examination. He will often also order all appropriate tests before he sees you to streamline your management and avoid unnecessary appointments. All tests are bulk billed where possible and they may include ultrasounds, CT scans or blood tests.  In some cases, additional tests and appointments may be required.

Based upon Mr Ponosh’s expert specialized review, an appropriate treatment plan will be suggested. All treatments for ulcers will be explained to you in an open, easy to understand manner with all options and questions addressed.

Treatment Options for Leg & Other Ulcers

The key to curing your ulcers and easing the leg pain caused, is the appropriate diagnosis and treatment of their underlying causes. Treating ulcers effectively also relies on a team approach, which Mr Ponosh will supervise and co-ordinate.

Mr Ponosh’s multidisciplinary ulcer treatment team includes:

  1. Wound Care Nurses (including his Practice Nurse, Silver Chain, Health Choices and the Hollywood Hospital Wound Service)
  2. Podiatrists (including private podiatrists and the High-Risk Services at Sir Charles Gardiner and Midland Hospitals
  3. Infectious Disease Physicians (for often complicated infections)
  4. Plastic Surgeons (if your ulcer is a large skin cancer)
  5. Diabetic Specialists

In most cases these ulcer treatments can be undertaken as an outpatient with Mr Ponosh managing you through his rooms but occasionally if more severe, you may need to be admitted to hospital for more appropriate treatment.

Leg & Ulcer Treatment may include:

  1. Imaging
    1. Ultrasounds or CT scans to identify arterial or venous causes
    2. Bone Scan or MRI scans to ensure no bone or deep tissue infections
  2. Wound swabs to rule out or diagnose specific infections
  3. Skin biopsies to rule out skin cancers or unusual skin conditions
  4. Blood tests
  5. Wound care & dressings
    1. There is a vast array of different dressings and Mr Ponosh will directly liaise with wound care nurses to continue them at home
  6. Compression bandaging or stockings
    1. Some conditions such as venous ulcers need tight bandaging or stockings to help the wound heal
    2. This may be required for weeks to months
  7. Antibiotics (oral or intravenous)
  8. Minimally invasive treatments or surgery
    1. Wound debridement or cleaning – for very infected or severe ulcers
    2. Vein treatments
    3. Arterial treatments
    4. Skin cancer surgery
    5. Skin grafts
    6. Toe or other amputations (very rare)

How Long Until My Ulcer Heals?

Some ulcers will be relatively simple to treat over a few weeks, however other ulcers may take many weeks or months to heal even with aggressive treatment. Patience, persistence and compliance is the key to healing these wounds.

In almost all cases we are able to completely heal the ulcer with the appropriate treatment however, on rare occasions we encounter unusual ulcers that do not heal.  Ulcers, especially in damaged skin such as venous ulcers do have a tendency to recur however, with Mr Ponosh’s advice and expert ulcer treatment plans, this is a very infrequent and rare outcome.