Leg Ulcer Watch: Unveiling the Trends, Incidence, and Healing Breakthroughs in Primary Care
"A deep dive into venous leg ulcer research reveals surprising shifts in prevalence, healing times, and treatment approaches, particularly in women over 70."
Lower-extremity wounds (LEWs), particularly venous leg ulcers (VLUs), present a significant challenge to patients, healthcare systems, and society. These chronic wounds not only affect quality of life but also place a heavy burden on healthcare resources, particularly through increased nursing consultations in primary care.
With an aging global population, the prevalence of chronic wounds, including VLUs, is on the rise. Studies indicate that a substantial percentage of individuals will develop a chronic wound during their lifetime, highlighting the urgent need for effective management and preventative strategies.
While only a small fraction of wounds heal quickly, the majority become chronic, leading to substantial costs for both individuals and healthcare systems. Given these challenges, understanding the epidemiology, healing patterns, and treatment approaches for VLUs is critical.
Guidelines and Comprehensive Care
Venous leg ulcers are the leading chronic wounds in the lower extremities and indicate severe chronic venous disease. Current management guidance includes standard compression therapy, while selected patients with infrainguinal deep venous obstruction may also be considered for autogenous venous bypass or endophlebectomy to support healing and prevent recurrence. A 2019 review used the AGREE structured assessment tool to evaluate the quality of venous leg ulcer clinical practice guidelines, helping healthcare professionals choose guidance appropriate for practice. The 2025 evidence-based editorial focuses on treatment options endorsed by the European Society for Vascular Surgery's 2022 Clinical Practice Guidelines.
From Early Observations to Modern Care
Leg ulcers have attracted the attention of medical writers since early times because of their common occurrence and difficulty of cure. The historical literature describes important contributions by physicians to the understanding and management of venous leg ulcers. A review published in 2013 emphasizes that these earlier clinicians demonstrated notable insight into venous anatomy and the pathophysiology of venous disorders. Another literature review reports that venous leg ulcers have existed since the 1200s and identifies early intervention with combined treatments as an important management approach.
What the Latest Research Reveals About Leg Ulcer Trends
A retrospective time series study conducted between 2010 and 2014 in a primary care center in Barcelona City provides valuable insights into venous leg ulcers. The research, which examined electronic health records of over 3,920 patients, focused on analyzing trends in prevalence and healing outcomes.
- Increased Prevalence and Incidence: Both the prevalence and incidence of VLUs increased over the study period, with a notable doubling in patients aged over 65.
- Improved Healing Times: Despite the increased occurrence, the time taken for lesions to heal decreased significantly, indicating advancements in treatment approaches.
- Enhanced Use of ABPI: The Ankle-Brachial Pressure Index (ABPI), a crucial diagnostic tool, was increasingly performed before the appearance of lesions, leading to earlier diagnosis and intervention.
- Demographic Insights: VLUs predominantly affected women over the age of 70, reinforcing the importance of targeted preventative measures for this demographic.
Emerging Therapies and Real-World Evidence
A systematic review and meta-analysis examining platelet-rich plasma and platelet-rich fibrin notes that venous leg ulcers affect more than 0.3% of adults, with incidence doubling in people over 65. In a prospective observational study, venoactive drugs combined with compression therapy were associated with complete healing in 70% of patients, with a mean healing time of 7.4 months. A 2026 Spanish analysis is evaluating polyacrylate superabsorbent wound dressings against foam dressings for moderate-to-highly exuding leg ulcers, using 14-day wound-area reduction data from three eligible studies. These findings represent different evidence types and should not be treated as a single comparative result.
Why Healing Remains Difficult
Venous leg ulcers are described as the most common type of ulcer in the lower extremity and can create substantial physical, psychological, and socioeconomic burdens. They usually occur on the medial lower leg between the ankle and knee as a consequence of chronic venous insufficiency or ambulatory venous hypertension. One management source defines a venous leg ulcer as showing little progress toward healing within 4–6 weeks of initial occurrence. The difficulty of healing is also associated with conditions such as post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension.
Evidence and Treatment Comparisons
Epidemiology can inform decision-making, but the cited study of hospital executives found that 98.7 percent of individuals who did not use epidemiology attributed that choice to cost or unfamiliar language. Separately, a September 2025 US-based real-world evidence study compares single-use negative pressure wound therapy with traditional negative pressure wound therapy for lower-extremity ulcers. The evaluated ulcers include diabetic foot ulcers and venous leg ulcers. The available source descriptions establish the comparison's population and design but do not provide comparative outcome figures.
The Role of Dedicated Wound Care and Future Directions
The study suggests that organizational changes, such as the establishment of dedicated wound units with reference nurses, can positively influence VLU care and healing outcomes. These dedicated services lead to quicker healing times and improved diagnostic accuracy. Future research should focus on exploring the long-term effects of these interventions and identifying best practices for VLU management to reduce the burden on patients and healthcare systems.
Pain and Quality of Life
Pain is described as a serious problem for people with leg ulcers, and research has often focused on pain caused by dressing changes. The cited systematic review also emphasizes that chronic background pain may be equally devastating. Chronic venous disease is prevalent in aging populations and can lead to venous leg ulcers that last and recur for years. As a result, venous leg ulcers can significantly affect quality of life alongside the clinical challenges of diagnosis and treatment.
Living With Chronic Wounds
Chronic venous insufficiency can lead to venous ulcerations, which one case report describes as accounting for 80% of all leg ulcerations. The report states that surgical treatment of the underlying venous insufficiency and conservative compression therapy may not be enough to close a chronic venous ulcer alone. Comprehensive care described in the report includes compression therapy and local wound care. A separate case report follows a patient living with two longstanding venous leg ulcers and highlights how the wounds affected her quality of life and could delay healing.