The ankle is the one place where all three major leg wound types meet, and that is the first thing worth knowing about a wound there.
Most venous ulcers occur on the leg, above the ankle. Ischemic ulcers may appear on the legs, ankles, toes, and between the toes. And ankles are among the places pressure sores tend to form.
Three wounds, one spot — and they are treated in opposite directions. For a venous ulcer: wear compression stockings or bandages every day as instructed, because they help prevent blood from pooling, reduce swelling, help with healing, and reduce pain. For an ischemic ulcer: do not wear compression stockings or wraps unless told to by your provider, because these may restrict blood flow. For a pressure sore: relieve the pressure, reposition, and use cushions or pads chosen with a provider.
So a wound at the ankle that is not healing raises a specific question before any other — what kind of wound it is. Checking the blood flow in the area around the wound is one of the four things a wound care team does at a first appointment, and that is the finding this turns on.
The most common of the three at this site has its own warning signs, which appear before any sore. Signs of venous insufficiency include itchy, thin skin with faint light red discoloration, called stasis dermatitis; leg swelling, heaviness and cramping; dark red, purple, brown, hardened skin, which is a sign that blood is pooling; and itching and tingling.
Beyond the wound type, the general list applies: infection, diabetes, poor circulation due to damage to arteries or veins, nerve damage, bone infection, being inactive or immobile, a weak immune system, poor nutrition, excess alcohol use, smoking, and a foreign body in the wound.
And the numbers: a wound is called non-healing if it has not started to heal in 2 weeks, or has not completely healed in 6 weeks. Venous ulcers can be slow to heal.