History

A comprehensive history is vital in making a diagnosis of any leg ulcer. These should include:

• general health status
• past and current medical history of relevant diseases e.g. - deep vein thrombosis, diabetes, autoimmune disorders, inflammatory bowel disease, and connective tissue disease
• history and status of the ulcer
  • rapidity of onset
  • preceding events, e.g. trauma or surgery at the site of the ulcer
  • duration of ulceration; gives an indication of chronicity and likelihood of successful treatment
  • previous treatment
  • whether it is a first episode or recurrent
  • symptoms:
    • venous disease:
      • pain
      • 'heaviness'
      • aching
      • itching
      • swelling
      • pigmentation
      • eczema
    • arterial:
      • intermittent claudication
      • pain, which persists at rest
• relevant predisposing factors
  • venous disease:
  • varicose veins
  • deep vein thrombosis in past
  • phlebitis
  • previous fractures, trauma or surgery
  • arterial disease:
    • ischaemic heart disease
    • transient ischaemic attacks of cerebrovascular events
    • peripheral vascular disease
    • cigarette smoking
    • hypertension
    • hypercholesterolaemia
    • diabetes mellitus
    • rheumatoid arthritis
• family history e.g. venous disease, diabetes mellitus
• recent foreign travel; may be suggestive of rare infective aetiologies
• ambulatory status of patient
• type of footwear worn
• patient psychological status; likely compliance with treatment
• nutrition (1,2,3)

Quality of life in patients with leg ulcers has shown to be poor when compared with age matched controls.

• pain was the major complaint with males experiencing greater pain intensity than females
• in addition restricted mobility, sleep disturbances etc are responsible for poor quality of life (2,3)

Reference:

• (1) Clinical Knowledge Summaries 2008. Leg ulcer-venous
• (2) Adeyi A et al. Leg ulcers in older people: A review of management. BJMP 2009;2(3):21-28
• (3) Agale SV. Chronic Leg Ulcers: Epidemiology, Aetiopathogenesis, and Management. Ulcers 2013;vol. 2013, Article ID 413604, 9 pages