Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Venous leg ulcers — wounds of the lower leg caused by chronic venous insufficiency and sustained venous hypertension — are the most common cause of chronic lower extremity wounds, affecting 1–2% of the adult population and representing a major podiatric management burden. Unlike diabetic foot ulcers (which occur from neuropathy and arterial disease), venous ulcers are driven by a specific pathophysiology — chronic venous hypertension causing dermal inflammation, lipodermatosclerosis, and ultimately ulceration — and the cornerstone of treatment is compression therapy that addresses this underlying mechanism.

Pathophysiology and Clinical Recognition

Chronic venous insufficiency results from incompetent venous valves (from prior deep vein thrombosis, venous varicosities, or primary valve incompetence), producing persistent high venous pressure in the lower leg — particularly the gaiter zone (the medial lower leg between the ankle and mid-calf). The sustained venous hypertension drives fluid and red cells into the dermis — producing the characteristic lipodermatosclerosis (indurated, woody skin), hemosiderin staining (brown discoloration from extravasated red cells), atrophie blanche (white scarred skin with stippled vessels), and ultimately ulceration at the most pressure-affected areas. Venous ulcer characteristics: located in the gaiter zone (medial lower leg); shallow, irregular borders; weeping exudate; surrounding lipodermatosclerosis and hemosiderin staining; typically painful but not as severely as arterial ulcers. The ABI (ankle-brachial index) must be measured before compression therapy — if ABI <0.6, compression is contraindicated (arterial disease is co-existent).

Treatment and Recurrence Prevention

Compression therapy: the definitive treatment — reduces venous hypertension by mechanically assisting venous return. Four-layer compression bandaging (the Charing Cross protocol) applies 40mmHg at the ankle, reducing to 17mmHg at the knee — evidence shows 70% healing at 12 weeks. Compression stockings (30–40mmHg class III medical compression) for maintenance after healing — must be worn lifelong. Local wound care: moisture-balanced dressings (foam, hydrocolloid, or alginate based on exudate level); compression over the dressing; weekly or twice-weekly dressing changes. Recurrence prevention: the major challenge in venous ulcers — 70% recur within 5 years without consistent compression use. Dr. Biernacki at Balance Foot & Ankle manages venous leg ulcers with advanced wound care and compression therapy at both Bloomfield Hills and Howell offices. Call (810) 206-1402 to schedule wound care evaluation.

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When to See a Podiatrist

Many foot conditions can be managed conservatively at home, but some require professional evaluation. See a podiatrist promptly if you experience:

• Pain that persists for more than 2 weeks despite rest
• Swelling, redness, or warmth that isn’t improving
• Numbness, tingling, or burning in the feet
• A wound or sore that is not healing within 2 weeks
• Any foot concern if you have diabetes or poor circulation
• Nail changes that suggest fungal infection or other problems

At Balance Foot & Ankle, our three board-certified podiatrists — Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin — provide comprehensive foot and ankle care at our Howell and Bloomfield Township offices. Most insurance plans are accepted.

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Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

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Venous Stasis Ulcer Treatment in Michigan

Chronic venous leg ulcers require expert wound care and compression therapy to heal. Our podiatrists provide comprehensive wound management including debridement, advanced dressings, and compression protocols to close venous ulcers and prevent recurrence.

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Clinical References

1. O’Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012;(11):CD000265.
2. Nelzen O, Bergqvist D, Lindhagen A. Venous and non-venous leg ulcers: clinical history and appearance in a population study. Br J Surg. 1994;81(2):182-187.
3. Margolis DJ, Berlin JA, Strom BL. Risk factors associated with the failure of a venous leg ulcer to heal. Arch Dermatol. 1999;135(8):920-926.