What Causes Leg Pain and Ulcers?

shutterstock_172461722_smallLeg pain can be caused by many things. As we age, poor circulation becomes a more common cause. You can have poor blood flow getting to your feet (by way of the arteries) or getting blood to flow back to the heart (by way of the veins). The last stage of both these disorders is leg ulcers.  Patients with poor flow in the arteries tend to have far more pain, have ulcers in certain locations, and often notice faster progression.  However, no one can definitely determine the cause of an ulcer simply by its appearance. At Houston VIR, we will evaluate your blood flow in both directions.

Diseased Arteries

Poor circulation to your feet (arterial disease) is very underdiagnosed, far easier to treat early, and can lead to severe outcomes very quickly.  Also, in order to treat vein disease, we must make sure there is adequate blood flow to your feet first. This is necessary because treating vein disease involves using compression which can make arterial disease worse.

Leg ulcers caused by too little blood flow to your legs (arterial ulcers) are a sign of tissue death. If untreated, or if they are ignored too long, they will result in amputations. Your arterial blood flow should be checked (regardless if you have pain) if you are:

  • Over age 60
  • Over 5 years removed from menopause
  • Diabetic (may not feel the pain)
  • Have had a heart attack
  • Have high blood pressure (and over the age of 55)
  • Have a family history of heart attack or vascular disease before the age of 40

Diseased Veins

Leg ulcers caused by poor blood flow back to your heart, can be present for months and years. These vein conditions are known as “venous leg ulcers.” These leg ulcers are caused by poor circulation that causes blood to pool in the lower extremities. As the blood pools, the tissue around the veins begins to break down, creating an ulcer. The poor circulation may be caused by venous insufficiency, or a vein that is blocked.

Differences in Leg Pain

Patients with poor blood flow to their legs (arterial disease) will be limited in their ability to walk or exercise.  Typically their pain comes on after a short period of activity which forces them to stop and rest.  They may also have pain that wakes them at night that is relieved by hanging their legs off the bed or standing up.

With vein disease, leg pain is usually present after prolonged standing or after completing exercise.  During exercise there is usually no pain.  You may be awaked by cramps at night which are relieved by walking or massaging.

Location of Ulcers

Venous leg ulcers typically occur on the sides of your lower legs between your ankle and calf. If you have ulcers on other areas of your legs, they may be arterial skin ulcers or neuropathic skin ulcers. Arterial skin ulcers typically occur on your toes and feet. Patients with diabetes are especially at risk for neuropathic skin ulcers. Your physician can diagnose they type of leg ulcer you are experiencing, and recommend an appropriate treatment plan.

What are the Symptoms of Leg Ulcers?

Leg ulcers are typically dark red or purple around the point where the ulcer is bleeding. The skin around the ulcer may be thick, itchy and dry. You may also experience pain, swelling and aching in your legs. Leg ulcers can become infected. When the leg ulcer is infected, you may notice an unpleasant odor, pus and increased tenderness and redness.

How are Leg Ulcers Diagnosed?

Leg ulcers are typically diagnosed by a complete medical examination, including your medical history, and a test to determine how well the blood is flowing in your legs. Other tests may be required if the leg ulcer does not respond to treatment.


At Houston VIR, we use the newest, and best, tests to determine your blood flow problem. We can also treat problems with both the arteries and veins. We are far more than a “vein” center, and we are the medical specialty that has pioneered the latest treatments for both conditions.

If our doctor feels your symptoms are being caused by venous insufficiency, treatments will be focused on shutting down the blood flow to the diseased veins which diverts the blood flow to healthy veins deeper in your legs.

If our doctor feels your symptoms are related to blockages in the arteries feeding your legs, then treatment will be focused on clearing the blockages and opening up the arteries to allow increased blood flow to your legs.