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Varicose ulcers - symptoms, description and treatment

Revision

Obrázek: Bércový vřed
Photo: tibial ulcer

Does a small scratch or abrasion turn into a swollen, hard-to-heal wound? Or does a scab form that cracks and the wound becomes infected? It may be a tibial ulcer, ulcus cruris in Latin. These are painful and difficult to treat wounds that can have a serious impact on your daily life. The resulting wound often serves as a gateway for infections. The disease often affects people with reduced vascular blood flow, diabetics.

Find out what are the treatment options for tibial ulcers. How to suppress symptoms such as pain, inflammation and poor blood circulation that accompany this disease? Read more here.

Typhoid ulcers symptoms

  • Painful wound on the shin or in the foot area
  • The Itch
  • The Island
  • Change in skin colour on the foot
  • Feeling of heavy legs
  • Signs of infection (fever, weakness)
  • Unpleasant smelling fluid coming from the wound [1]
Notice

Only a doctor can make a correct diagnosis. Do not use this or any other article on the internet to make a diagnosis. Don’t put off seeing a doctor and address your condition early.

Description and causes of tibial ulcers

Obrázek ukazuje jak vypadá bércový vřed na noze
Picture shows what a tibial ulcer on the leg looks like

Definition of tibial ulcer

What is a tibial ulcer? It is a long-term disruption of tissue and the formation of a wound in the tibia area. The tibia is the part of the leg between the ankle and the knee. It consists of the calf (back of the leg) and the shin (front of the leg). However, ulcers can also occur between the toes or on the toes. [2][3]

A tibial ulcer can vary in size, shape, colour and other characteristics. The exact form and mode of occurrence depends on what is the cause of the tibial ulcers.

Some patients may be able to recognize the onset of a tibial ulcer by swelling of the lower extremities, darkening of the skin, and thinning of the skin. The skin is then more susceptible to injury and subsequent ulceration. [4]

Do not underestimate the first symptoms. If you suspect that a tibial ulcer is starting, see a doctor in its early stages.

Tiber ulcers - causes

The primary cause of tibial ulcers is vascular disease. Typhoid ulcers are not a disease in themselves, but a symptom of some other disease.

  • 73% of tibial ulcers are venous in origin. Professionally, venous ulcers are called ulcus cruris venosum.
  • 8% of ulcers are related to artery disease. Doctors talk about an arterial ulcer – ulcus cruris arteriosum.
  • 3% of tibial ulcers are caused by diabetes.
  • 2% of ulcers occur after trauma.
  • 14% of ulcers have other causes. If there are several causes at the same time, it is ulcus cruris mixtum.[5]

Types of tibial ulcers and their description

  • Tiber ulcer of venous origin
    It is caused by the accumulation of venous blood in the legs. It is a complication of chronic venous insufficiency. [6 ] Risk factors include a history of inflammation in the deep venous system, hereditary predisposition to venous disease, obesity, lack of exercise and sedentary occupation[7].
    What do venous ulcers look like? They are usually smaller, shallow and have smooth edges. They are less painful than other types of tibial ulcers. If patients report pain, it is usually related to the onset of inflammation. [8]

  • Tiber ulcer of arterial origin

    Arterial ulcers arise due to diseases of the arteries that affect the lower limbs. The main problem is the narrowing of the arteries. They occur more often in the elderly and in patients with high blood pressure.
    What do arterial ulcers look like? They are most commonly found on the heel, on the toes and around the ankle. Compared to other ulcers, they are deeper and have pronounced margins. Typical is great soreness, which intensifies at night when the legs are laid flat on the bed.[9]

  • Diabetic tibial ulcer

    It is associated not only with diseases of the arteries and nerves on the peripheral parts of the body, but also with high blood sugar.[10]
    What do tibial ulcers look like in diabetes? They appear on the toes, on the soles of the feet and on the shins. The ulcers are not large, but they are deep and can extend to the bone. There is hardened skin around the ulcer.[11] More on the diabetic foot diagnosis page.
  • Other types of tibial ulcers
    Tiber ulcers can also be related to a number of other diseases. They occur, for example, in patients with rheumatoid arthritis (an autoimmune disease affecting the joints), in some cancers or in intestinal inflammation.[12]

Risk factors for tibial ulcers

Seniors areat risk of developing tibial ulcers, especially if they have diabetes, high blood pressure and are overweight. [13]
The risk also increases:

  • deep vein thrombosis (a blood clot that clogs a vein),
  • varicose veins on the legs,
  • a previous fracture, injury or surgery to the leg that restricts walking and impairs blood flow.[14]

Diagnostics - how to recognize tibial ulcers?

If you suspect a tibial ulcer, see a doctor as soon as possible. Without proper treatment, tibial ulcers will not heal on their own. The doctor must determine the cause of their occurrence, otherwise the risk of worsening the condition or recurrence of ulcers increases.[15]

How is the examination of tibial ulcers carried out?

The first step is to find out information – so expect questions about the start of the problem, your general health and your employment. The doctor will then examine you carefully and determine further tests accordingly.

  • The condition of the feet, location, size, shape and characteristics of the ulcers are determined by inspection. The doctor also monitors the possible appearance of varicose veins, swelling and skin color. All this is done standing and lying down.
  • By palpation, the doctor assesses the temperature and tension of the skin, swelling and the characteristics of the ulcer itself.
  • During the blood draw, blood count, blood sugar and other values are checked.
  • In some cases, a tissue sample is taken from the tibial ulcer for microbiological examination. [16]

Doppler test

Dopplerův test – vyšetření bércových vředů
Doppler test - examination of tibial ulcers

The Doppler test is an ultrasound examination of the blood vessels in the legs. In addition to displaying blood vessels, it can measure blood flow velocity. Thanks to this painless examination, the doctor gets an overview of the possible vascular causes of tibial ulcers.

The examination is usually accompanied by a check of blood pressure in the ankle area to assess the ankle index.[17]

Did you know ?

  • Up to 5% of people over the age of 70 suffer from tibial ulcers.
  • The majority (80%) of ulcers are caused by vascular insufficiency.
  • The most common complication of tibial ulcers is infection. [18]

Complications of non-treatment

If a tibial ulcer is not treated or the treatment is not effective, complications can occur with a significant impact on your life.

  • Infection: an open wound resulting from a tibial ulcer is a gateway for infection.
  • Chronic pain: untreated can lead to permanent pain and limitations in daily life.
  • Swelling and fever: Harmful microorganisms enter through an open wound and cause redness, swelling and fever.
  • Rosacea: It is a bacterial infection of the skin.
Infekce

Infection

Chronická bolest

Chronic pain

Otok a horečka

Swelling and fever

Růže

Roses

Notice

We recommend not to postpone treatment of tibial ulcers

Do not delay treatment for a tibial ulcer and see a specialist if you have any health problems or doubts about your health. This will prevent unnecessary health complications.

Treatment of tibial ulcers

Treatment of tibial ulcers is carried out in several ways. Doctors from different disciplines work together.

Local treatment involves taking care of the ulcer itself, which must be cleaned and then treated with special preparations so that the wound can heal successfully. Dead tissue impedes healing, which is why its removal is so important.

The wound then requires the maintenance of a reasonably moist environment. This is helped by a number of modern means for so-called moist healing. [19]

Compression therapy belongs to the standard treatment of tibial ulcers. It uses compression (tightening) elastic stockings or a bandage. The aim is to promote the proper functioning of the blood circulation.[20] The decision whether to use stockings or bandages depends on the stage of the disease, the condition of the lower limbs and the patient’s cooperation. In general, elastic bandages are used in the acute phase and tightening stockings in long-term treatment. Compression therapy is not used, for example, in patients with severe heart problems. [21]

The overall treatment of tibial ulcers depends on what is causing them. Various drugs are used to treat vascular diseases, which counteract swelling, promote blood flow and have an anti-inflammatory effect. Patients also take medication for other conditions (such as diabetes). Pain killers are also sometimes needed and antibiotics in case of infection. [22][23]

Invasive treatment (surgery) comes into play when there is a need to improve blood circulation to the leg and to treat non-healing tibial ulcers with vascular surgery. [24] Surgery for tibial ulcers is performed at a specialised vascular surgery unit where different types of surgery are performed.

Notice

Attention

The treatment of tibial ulcers can only be determined by your doctor after considering your overall health. Therefore, do not use this article as a guide to treatment, which can only be determined by a doctor.

Moist wound healing - also helps with tibial ulcers

Převaz bércových vředů – hojení podpoří speciální krycí obvazy
Bandage of tibial ulcers - healing will be supported by special cover bandages

There is a wide range of products that are used in wound care and also help in the treatment of tibial ulcers. You should therefore leave the choice of the appropriate cover for ulcers to your doctor.

Various gels, dressings called hydrocolloids, seaweed coverings or special dressings that absorb secretions (fluid) from the tibial ulcer are used for treatment. A covering containing silver also helps in the treatment of chronic wounds. [25]

Home treatment of tibial ulcers - grandmotherly advice

In home care for tibial ulcer, various regimen measures and herbal products are used.

  • Treat your body with substances called bioflavonoids. They are contained in, for example, blueberries, parsley, horseradish and red cabbage.
  • Include rosehip tea in your drinking regime.
  • Make sure your feet are warm and wear socks that don’t pinch. Both are important for maintaining good blood circulation. Poor blood circulation creates conditions for the development of tibial ulcers.
  • Poultices for tibial ulcers can be prepared from horsetail or horsetail root. [26]

What to lubricate tibial ulcers with? You can try ointment from calendula or marigold. These are herbs with healing effects.
Before you reach for herbs, whether in the form of teas or directly for wound care, consult your doctor. Caution is needed when using herbs, especially if you are taking medication.

However, grandmotherly advice for tibial ulcers may not be effective as a full-fledged modern treatment, we always recommend visiting a specialist and discussing the treatment with him.

Prevention of tibial ulcers

The best cure for tibial ulcers is prevention. The following steps are important for her. They mainly concern at-risk groups and people who have had a history of tibial ulcers.

  • Follow the prescribed treatment for diseases that can cause tibial ulcers (for example, diabetes or high blood pressure).
  • Try to lose weight if you are overweight.
  • Stop smoking cigarettes.
  • Regularly engage in physical activities.
  • Take care of your feet – prop them up when you sit at work and regularly give them a raised position at home.
  • Ask your doctor how often to wear tightening stockings. [27][28]

Tiber ulcers and baths

Ask your doctor about spa treatment options for tibial ulcers. It will tell you all the latest information and specific recommendations. Various special methods of ulcer care are used in the spa – for example, light therapy or electromagnets (magnetotherapy). [29][30]

Notice

Important cautions when dealing with tibial ulcers

Typhoid ulcers require medical attention.

Take care of your feet.

Move regularly – you promote blood circulation.

When treating tibial ulcers, do not automatically “demand” antibiotics.

Summary and recommendations for the management of tibial ulcers

1.

See a doctor

The treatment of a tibial ulcer is always determined by a doctor based on a general examination, an assessment of your health and an accurate diagnosis.

2.

Causal treatment of tibial ulcer

After a general examination, your doctor will recommend treatment for the cause of the tibial ulcer. They will also advise you on possible lifestyle adjustments and the next course of action.

3.

Relieving pain, improving blood circulation and resolving inflammation

Symptomatic treatment focuses on the manifestations or signs (symptoms) of the disease. Such treatment can significantly improve your quality of life and support comprehensive treatment during the course of the disease.

Sources, references and literature

[1] Venous leg ulcer. NHS, 16. November 2022. https://www.nhs.uk/conditions/leg-ulcer/

[2] Stryja J. Treatment of infected tibial ulcer. Dermatol. Practice 2021; 15(4): 191-194. https://www.solen.cz/pdfs/der/2021/04/03.pdf

[3] Venous leg ulcer. NHS, 16. November 2022. https://www.nhs.uk/conditions/leg-ulcer/

[4] Karen I., Švestková S. Chronic ulcer of the lower limb. Recommended diagnostic and therapeutic procedure for general practitioners. Society of General Medicine ČLS, Prague 2007. https://www.svl.cz/files/files/Doporucene-postupy-2003-2007/Vred-DK.pdf

[5] Karen I., Švestková S. Chronic ulcer of the lower limb. Recommended diagnostic and therapeutic procedure for general practitioners. Society of General Medicine ČLS, Prague 2007. https://www.svl.cz/files/files/Doporucene-postupy-2003-2007/Vred-DK.pdf

[6] Venous leg ulcer. NHS, 16. November 2022. https://www.nhs.uk/conditions/leg-ulcer/

[7] Karen I., Švestková S. Chronic ulcer of the lower limb. Recommended diagnostic and therapeutic procedure for general practitioners. Society of General Medicine ČLS, Prague 2007. https://www.svl.cz/files/files/Doporucene-postupy-2003-2007/Vred-DK.pdf

[8] Karen I., Švestková S. Chronic ulcer of the lower limb. Recommended diagnostic and therapeutic procedure for general practitioners. Society of General Medicine ČLS, Prague 2007. https://www.svl.cz/files/files/Doporucene-postupy-2003-2007/Vred-DK.pdf

[9] Karen I., Švestková S. Chronic ulcer of the lower limb. Recommended diagnostic and therapeutic procedure for general practitioners. Society of General Medicine ČLS, Prague 2007. https://www.svl.cz/files/files/Doporucene-postupy-2003-2007/Vred-DK.pdf

[10] Venous leg ulcer. NHS, 16. November 2022. https://www.nhs.uk/conditions/leg-ulcer/

[11] Karen I., Švestková S. Chronic ulcer of the lower limb. Recommended diagnostic and therapeutic procedure for general practitioners. Society of General Medicine ČLS, Prague 2007. https://www.svl.cz/files/files/Doporucene-postupy-2003-2007/Vred-DK.pdf

[12] Karen I., Švestková S. Chronic ulcer of the lower limb. Recommended diagnostic and therapeutic procedure for general practitioners. Society of General Medicine ČLS, Prague 2007. https://www.svl.cz/files/files/Doporucene-postupy-2003-2007/Vred-DK.pdf

[13] Leg ulcers. Healthdirect Australia, April 2021. https://www.healthdirect.gov.au/leg-ulcers

[14] Venous leg ulcer. NHS, 16. November 2022. https://www.nhs.uk/conditions/leg-ulcer/

[15] Venous leg ulcer. NHS, 16. November 2022. https://www.nhs.uk/conditions/leg-ulcer/

[16] Karen I., Švestková S. Chronic ulcer of the lower limb. Recommended diagnostic and therapeutic procedure for general practitioners. Society of General Medicine ČLS, Prague 2007. https://www.svl.cz/files/files/Doporucene-postupy-2003-2007/Vred-DK.pdf

[17] Venous leg ulcer. NHS, 16. November 2022. https://www.nhs.uk/conditions/leg-ulcer/

[18] Stryja J. Treatment of infected tibial ulcer. Dermatol. Practice 2021; 15(4): 191-194. https://www.solen.cz/pdfs/der/2021/04/03.pdf

[19] Karen I., Švestková S. Chronic ulcer of the lower limb. Recommended diagnostic and therapeutic procedure for general practitioners. Society of General Medicine ČLS, Prague 2007. https://www.svl.cz/files/files/Doporucene-postupy-2003-2007/Vred-DK.pdf

[20] Venous leg ulcer. NHS, 16. November 2022. https://www.nhs.uk/conditions/leg-ulcer/

[21] Karen I., Švestková S. Chronic ulcer of the lower limb. Recommended diagnostic and therapeutic procedure for general practitioners. Society of General Medicine ČLS, Prague 2007. https://www.svl.cz/files/files/Doporucene-postupy-2003-2007/Vred-DK.pdf

[22] Karen I., Švestková S. Chronic ulcer of the lower limb. Recommended diagnostic and therapeutic procedure for general practitioners. Society of General Medicine ČLS, Prague 2007. https://www.svl.cz/files/files/Doporucene-postupy-2003-2007/Vred-DK.pdf

[23] Venous leg ulcer. NHS, 16. November 2022. https://www.nhs.uk/conditions/leg-ulcer/

[24] Venous leg ulcer. NHS, 16. November 2022. https://www.nhs.uk/conditions/leg-ulcer/

[25] Karen I., Švestková S. Chronic ulcer of the lower limb. Recommended diagnostic and therapeutic procedure for general practitioners. Society of General Medicine ČLS, Prague 2007. https://www.svl.cz/files/files/Doporucene-postupy-2003-2007/Vred-DK.pdf

[26] Mlčoch Z. Tongue ulcers – herbs, herbs, herbal advice, poultices, ointments, treatment, recommendations and measures. Herbs for all, 19. March 2015. https://www.bylinkyprovsechny.cz/nemoci/ruzne-nemoci/783-bercove-vredy-byliny-bylinky-babske-rady-obklady-masti-lecba-doporuceni-a-opatreni

[27] Venous leg ulcer. NHS, 16. November 2022. https://www.nhs.uk/conditions/leg-ulcer/

[28] Leg ulcers. Healthdirect Australia, April 2021. https://www.healthdirect.gov.au/leg-ulcers

[29] Electrotherapy. Spa hotel Prusik, Konstantinovy Lazne. https://www.konstantinovylazne.cz/cz/lecba/lecebne-procedury/elektrolecba/

[30] Magnetotherapy treatment. Karlova Studénka Mountain Spa. https://www.horskelazne.cz/bazen-a-procedury/procedury/magnetoterapie

How to control pain, swelling, inflammation and promote healing? Try the application of 3D magnetotherapy
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