Venous ulceration.

Ulcers in association with chronic venous insufficiency usually follow minor traum. Venous disease arises from calf muscle pump dysfunction. It is associated with prior deep venous thrombosis or cellulitis, incompetent (varicose) superficial or communicating veins and immobility.

About 1% of the middle-aged and elderly population is affected by leg ulceration, most commonly in association with chronic venous sufficiency (45-80%).
Venous insufficiency results in aching, swollen lower legs that feel more comfortable when elevated. Signs may include:

• Varicose veins
• Chronic lymphoedema
• Brawny stippled pigmentation
• Stasis dermatitis (scratched, dry or weeping patches)
• Atrophie blanche (scarring with prominent tortuous capillaries)
• Lipodermatosclerosis (firm to hard induration)
• Warty papillomatosis

A minor injury causes a punched-out ulcer that expands with an irregular brownish border. It may be painless or painful, dry or oozy. The most common site is the medial lower aspect of the calf especially over the malleolus. Multiple ulcers may occur.