Leg Ulcers

Mr Poskitt is a specialist in leg ulceration and is involved in research nationally, helping to improve knowledge and treatments for this distressing condition. He played a major role in defining the management of severe venous disorders (ESCHAR paper, The Lancet 2012; EVRA paper New England Journal of Medicine 2018).

In 1995 he set up the Gloucestershire Leg Ulcer Service and introduced the role of Duplex Guided Foam Sclerotherapy and Radiofrequency Ablation of leaky/refluxing superficial varicose veins to treat the venous hypertension which causes the ulceration.

What is a Leg Ulcer?

A leg ulcer is a wound below the knee which fails to show signs of healing for 4-6 weeks or more.

Venous leg ulcer
Venous leg ulcer demonstrating venous staining due to high venous pressure
Venous leg ulcer with some healthy red granulation tissue

What causes leg ulceration

A number of conditions may contribute to leg ulceration but the majority of leg ulcers are caused by venous disease (leaky venous valves) with a smaller number of legs having reduced blood supply due to narrowed or blocked arteries. Less common causes may be due to small vessel problems including diabetes or auto immune disease, and a very small number may be due to skin lesions including skin growths.


It is important to assess both your arteries and veins assessed with ABPI (Ankle Brachial Pressure Index) and duplex scanning of the deep and superficial veins to help diagnose the cause or aetiology of your leg ulcer. It is important to rule out significant arterial disease before treating legs with venous disease with compression therapy.

ABPI – blood pressure at the ankle
A venous duplex scan to help establish the cause of the leg ulcer


The principal treatment of venous ulceration is to reduce the effects of the venous hypertension. Elevation and compression both play an important role following excluding any significant arterial problem.

4 layer compression treatment providing 35-40mmHg pressure to improve the healing ability of the ulcer

Reducing the venous hypertension caused by the superficial venous reflux (due to leaky venous valves) plays the major role in optimising the healing process. Historically, this was performed by surgery but over the last 10-15 years, both duplex guided foam sclerotherapy and /or endothermal venous ablation are commonly used to help speed up ulcer healing and reducing ulcer recurrence (ESCHAR and EVRA research studies).

Foam sclerotherapy to ablate (block) the leaky veins high up in the leg and those close to/feeding the ulcer..
Radiofrequency ablation as an option

Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial – The Lancet

Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial | The BMJ

A Randomized Trial of Early Endovenous Ablation in Venous Ulceration | NEJM

NICE Management of Varicose Veins (CG168)
Overview | Varicose veins: diagnosis and management | Guidance | NICE