Venous Ulcers can look deceptively small: a shallow break near the ankle, surrounded by itchy, swollen skin. Yet healing may take months, and recurrence is common when the underlying venous pressure remains untreated. In 2026, the best approach is not one dressing or device. It is a plan that addresses circulation, protects the wound, and fits the person’s health and daily life.
Wound-care expert Dr. Robert Kirsner is associated with a useful cause-focused principle, paraphrased here: “Treat the cause, not only the wound.” Compression is often central to care, but it should follow clinical assessment, including checks for arterial disease. A clinician may also recommend dressings, leg elevation, movement, and treatment of superficial venous reflux. The right combination depends on the ulcer and the patient. Details matter.
This article examines what current evidence can—and cannot—say about the best treatment for Venous Ulcers. It compares compression options, wound-care practices, and procedures that may reduce recurrence. It also explains when specialist assessment is important. Healing is rarely a straight line. That can be frustrating. Even careful plans may need adjustment when pain, swelling, skin changes, or slow progress appear. The aim is practical guidance, not a promise of quick healing: readers should leave better prepared to discuss safe, individualized care with a qualified clinician.
Venous ulcers are not diagnosed by appearance alone. A shallow, irregular wound near the inner ankle, swelling, visible veins, or brown, itchy skin can suggest chronic venous disease. But arterial disease, diabetes, pressure injury, and infection can look similar or occur alongside it.
The European Society for Vascular Surgery’s 2022 guidelines estimate that venous disease causes about 70% of leg ulcers. That makes careful assessment essential.
Clinicians review medical history and record the wound’s location, size, depth, drainage, and surrounding skin.
Look beyond the wound.
Assessment may include checking pulses and measuring the ankle-brachial index (ABI), which compares ankle and arm blood pressure. This helps identify reduced arterial circulation before compression is considered.
Duplex ultrasound can assess venous reflux or obstruction; the ESVS guidelines identify it as the primary imaging test for chronic venous disease. Pain, swelling, and changes in skin temperature also matter.
One limitation: findings do not always point to a single cause, so reassessment may be needed as the wound changes.
Tips: Note when swelling worsens and what eases it. Bring a current medication list and any wound measurements to appointments. Seek prompt clinical advice for spreading redness, fever, or sudden increases in pain.
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