Why won’t the sore on my leg close?

Written by WISH Clinic

Clinically reviewed by Dr. Traci A. Kimball, MD, MBA

Last medical review

On a leg, the reason is usually underneath the wound. A venous ulcer needs vein pressure relieved, an arterial ulcer needs blood flow restored, and a pressure sore needs pressure taken off, so which kind you have decides everything, including whether compression helps or harms.

On a leg, the reason a sore won’t close is usually underneath the wound rather than in it. There are three kinds of leg wound with three different answers, and which one you have decides what has to change.

If it is a venous ulcer: the cause of venous ulcers is high pressure in the veins of the lower leg. The increase in pressure and buildup of fluid makes it more difficult for nutrients and oxygen to get to tissues. To help treat a venous ulcer, the high pressure in the leg veins needs to be relieved. That means compression stockings or bandages worn every day as instructed, feet above the heart as often as possible, and walking or exercising daily.

If it is an arterial, or ischemic, ulcer the answer is different. To treat an ischemic ulcer, blood flow to your legs needs to be restored. You may need to take medicine. In some cases, you may need surgery. And there is a warning that matters enormously if the two are confused: do not wear compression stockings or wraps unless told to by your provider. These may restrict blood flow.

Read those two paragraphs side by side, because that is the heart of this question. Compression is the treatment for one kind of leg ulcer and a warning for another. Knowing which kind you have is not a detail — it is the thing that decides whether the main treatment helps or harms.

If it is a pressure sore: pressure sores occur when there is too much pressure on the skin for too long. This reduces blood flow to the area. Heels and ankles are both places where they form, so a leg sore can be this as well.

There are marks to measure against and a list of reasons behind them. A wound is called non-healing if it has not started to heal in 2 weeks or has not completely healed in 6 weeks. Reasons wounds may not heal well include 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. To be honest about the outlook: non-healing wounds may take months to heal. Surgery may be performed to speed up healing. Some wounds never heal completely.

So the question to take with you is not why it hasn’t closed, which nobody can answer at a distance. It is: which kind of leg wound is this, and what established that — pulses, a blood flow test, an ultrasound, or an assumption?

What to watch for

Contact your provider if you notice signs of infection, such as redness, swelling, pus or bleeding from the wound, pain that gets worse, fever, or chills. A non-healing wound is one that has not started to heal in 2 weeks or has not completely healed in 6 weeks.

The most useful thing to take to an appointment is the question of type. Ask which kind of leg wound this is and what established it — pulses, an ankle-brachial index, an ultrasound, or an assumption. Ask it before compression is started or continued, because the same measure that treats one kind of leg ulcer is a warning for another.

What we look at

  • Which wound type this is, and whether that was established or assumed
  • Whether blood flow was assessed before compression was advised
  • Whether compression is being worn as instructed, and tolerated
  • Whether the 2-week or 6-week non-healing marks have passed
  • Which of the listed non-healing factors apply to this patient

Related questions

Sources

  1. MedlinePlus — Venous ulcers, self-care: https://medlineplus.gov/ency/patientinstructions/000744.htm
  2. MedlinePlus — Ischemic ulcers, self-care: https://medlineplus.gov/ency/patientinstructions/000742.htm
  3. MedlinePlus — How to care for pressure sores: https://medlineplus.gov/ency/patientinstructions/000740.htm
  4. MedlinePlus — Wound care centers: https://medlineplus.gov/ency/patientinstructions/000739.htm
Non-healing wound care at The WISH Clinic

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